Disease staging: CliniCal anD CoDeD Criteria - HCUP

Clinical Criteria with Description, Diagnostic Findings and ICD-9-CM codes
DXCat Number: PED18
MultiStage: No
DXCat Label: Drug Withdrawal Syndromes in Neonates Specificity: A
Etiology: Toxicologic
Stage Description Diagnostic findings ICD-9-CM Codes
1.01 Newborn infant with maternal drug Newborn
(DX 76071, 76072, 76073, 76075)
addiction
AND maternal addiction to narcotics
+ AGE 0;
OR maternal addiction to cocaine
OR maternal addiction to barbiturates
OR positive urine drug screen of the newborn as [toxicology report]
2.01 Newborn infant with maternal drug Stage 1.01
addiction, small for gestational age, with AND birth weight < 10th percentile for gestational age
asymmetric intrauterine growth retardation AND head circumference ≥ 10th percentile for gestational age
2.02 Newborn infant with maternal drug Stage 1.01
addiction, small for gestational age, with AND birth weight < 10th percentile for gestational age
symmetric inatrauterine growth retardation AND head circumference < 10th percentile for gestational age
2.03 with acute withdrawal syndrome Stage 1.01-2.02
AND irritability
AND increased tone
AND tremors
AND feeding difficulty
AND abnormal sleep patterns
2.04 with apnea Stage 1.01-2.03
AND respiratory pause > 20 seconds
OR respiratory pause < 20 seconds
AND cyanosis
AND pallor
AND hypotonia
AND heart rate < 100 bpm
2.05 with seizures Stage 1.01-2.04
AND seizures
3.01 with cerebral vascular accident Stage 1.01-2.05
AND Perinatal cerebral infarction, usually in the distribution of the middle cerebral artery
[CT or MRI report]
3.02 with respiratory failure Stage 1.01-3.01
AND respiratory failure:
STAGE 1.01 + (DX 76400-76409,
76490-76499);
NO;
DX 7795;
STAGE 1.01-2.02 + (DX 33385,
76077-76078);
STAGE 1.01-2.03 + (DX 33372,
35924, 7708);
STAGE 1.01-2.04 + DX 7790;
STAGE 1.01-2.05 + DX 77210-
77214;
STAGE 1.01-3.01 + GROUP
RESP_FAIL;
Thursday, January 07, 2010 9:22:59 AM
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