Disease staging: CliniCal anD CoDeD Criteria - HCUP

Clinical Criteria with Description, Diagnostic Findings and ICD-9-CM codes
DXCat Number: PED19
MultiStage: No
DXCat Label: Full Term Infant with Abnormal Birth Weight Specificity: A
Etiology: Congenital
Stage Description Diagnostic findings ICD-9-CM Codes
1.01 Full term infant, large for gestational age Infant ≥ 38 weeks and ≤ 42 weeks gestational age
DX 7660;
AND birth weight ≥ 90th percentile for gestational age
DX V3000-V392 + DX 7660;
1.02 Full term infant, small for gestational age, Infant ≥ 38 weeks and ≤ 42 weeks gestational age
DX 76400-76419, 76490-76499;
with asymmetric intrauterine growth AND birth weight < 10th percentile for gestational age
DX V3000-V392 + (DX 76400-
retardation
AND head circumference > 10th percentile for gestational age
76419, 76490-76499);
1.03 Full term infant, small for gestational age,
with symmetric intrauterine growth
retardation
Infant ≥ 38 weeks and ≤ 42 weeks gestational age
AND birth weight < 10th percentile for gestational age
AND head circumference < 10th percentile for gestational age
2.01 with hypocalcemia Stage 1.01-1.03
AND hypocalcemia:
2.02 with hypoglycemia Stage 1.01-2.01
AND hypoglycemia:
2.03 with hyperbilirubinemia Stage 1.01-2.02
AND Infants < 1 day old total serum bilirubin 8.0 mg/dl [chemistry report]
OR Infants 1-2 days old total serum bilirubin ≥ 12mg/dl [chemistry report]
OR Infants 2-5 days old total serum bilirubin ≥ 16mg/dl [chemistry report]
OR Infants > 5 days old total serum bilirubin ≥ 2mg/dl [chemistry report]
2.04 with polycythemia Stage 1.01-2.03
AND Central hematocrit > 65%
2.05 with seizures Stage 1.01-2.04
AND seizures
3.01 with persistent pulmonary hypertension Stage 1.01-2.05
AND Right to left shunting through a patent ductus arteriosus or patent foramen ovale
[ultrasound report]
AND PaO2 < 60mmHg unresponsive to 100% O2
OR PaO2 gradient between the radial artery and the umbilical artery > 20mmHg [ABG
report]
AND normal pCO2 [ABG report]
NO;
STAGE 1.01-1.02 + GROUP
HYPOCALCEMIA;
STAGE 1.01-2.01 + GROUP
HYPOGLYCEMIA;
STAGE 1.01-2.02 + GROUP
HYPERBILI;
STAGE 1.01-2.03 + DX 7764;
STAGE 1.01-2.04 + DX 7790;
STAGE 1.01-2.05 + (DX 4150,
4160, 4168);
3.02 with heart failure Stage 1.01-3.01
congestive heart failure:
3.03 with respiratory failure Stage 1.01-3.02
AND respiratory failure:
STAGE 1.01-3.01 + GROUP
CHF__NON_HTN;
STAGE 1.01-3.02 + GROUP
RESP_FAIL;
Thursday, January 07, 2010 9:22:59 AM
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