Disease staging: CliniCal anD CoDeD Criteria - HCUP

Clinical Criteria with Description, Diagnostic Findings and ICD-9-CM codes
DXCat Number: PED17
MultiStage: No
DXCat Label: Cytomegalovirus Disease (Congenital) Specificity: A
Etiology: Infection, Viral
Stage Description Diagnostic findings ICD-9-CM Codes
1.01 Asymptomatic congenital cytomegalovirus Newborn
DX 7711;
infection
AND isolation of cytomegalovirus from maternal amniotic fluid or infant’s uring or saliva at
< 2 weeks of age [virology culture report]
OR detection of IgM-specific cytomegalovirus virus antibody in the serum
[serology report]
AND no signs or symptoms of infection
2.01 Congenital cytomegalovirus infection with
preterm delivery
Newborn
AND Isolation of cytomegalovirus from maternal amniotic fluid or infant’s urine or saliva
[virology culture report]
OR detection of IgM or IgG-specific cytomegalovirus antibody in the serum
[serology report]
AND delivery at < 37 weeks gestation
STAGE 1.01 + DX 76500-76519;
2.02 Congenital cytomegalovirus infection with
intrauterine growth retardation
Newborn
AND Isolation of cytomegalovirus from maternal amniotic fluid or infant’s urine or saliva
[virology culture report]
OR detection of IgM or IgG -specific cytomegalovirus antibody in the serum
[serology report]
AND weight ≤ 10 th percentile for gestational age
2.03 Cytomegalovirus retinitis Stage 2.01-2.02
AND retinitis [ophthalomoloscopy report]
2.04 Cytomegalovirus retinitis with retinal Stage 2.01-2.03
hemorrhages or infiltrates or disk edema AND retinal hemorrhages [ophthalmoloscopy report]
OR sectoral infiltrates [ophthalmoloscopy report]
OR optic disk edema [ophthalmoloscopy report]
2.05 Cytomegalovirus retinitis with retinal Stage 2.01-2.04
detachment
AND retinal detachment [ophthalmoloscopy report]
OR iris neovascularization [ophthalmoloscopy report]
2.06 with hepatosplenomegaly and jaundice Stage 2.01-2.05
AND hepatosplenomegaly [sonography report or CT scan report or MRI report]
AND hyperbilirubinemia:
2.07 with sensorineural hearing loss Stage 1.01-2.06
AND sensorineural hearing loss [audiology report of BAEP report]
STAGE 1.01-2.01 + (DX 76400-
76409, 76490-76499);
STAGE 1.01-2.02 + DX 36300-
36322;
STAGE 1.01-2.03 + (DX 36281,
36289, 37700);
STAGE 1.01-2.04 + DXCAT EYE07;
STAGE 1.01-2.05 + (GROUP
HYPERBILI OR DX 5718);
STAGE 1.01-2.06 + DX 38910-
38922;
Thursday, January 07, 2010 9:22:58 AM
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