Disease staging: CliniCal anD CoDeD Criteria - HCUP

Clinical Criteria with Description, Diagnostic Findings and ICD-9-CM codes
DXCat Number: PED20
MultiStage: No
DXCat Label: Hyaline Membrane Disease/Respiratory Distress Syndrome Specificity: A
Etiology: Congenital
Stage Description Diagnostic findings ICD-9-CM Codes
2.01 Newborn infant with respiratory distress Newborn
DX 769, 7704-77083;
syndrome
AND RR ≥ 60 within several hours of birth
AND grunting, flaring or retractions
AND lung parenchyma with a reticular granularity ("ground glass" appearance) with air
bronchograms [chest x-ray report]
2.02 Respiratory distress syndrome with Stage 2.01
DX 7702-7703, 77087-7709;
interstitial emphysema or pneumothorax or AND Interstitial emphysema [x-ray report]
pneumomediastinum
OR pneumothorax [x-ray report]
OR pneumomediastinum [x-ray report]
3.01 with respiratory failure Stage 2.01-2.02
AND respiratory failure:
3.02 with asphyxia Stage 2.01-3.01
AND asphyxia
AND ph < 7.0 on umbilical artery sample [chemistry report]
AND Apgar score 0-3 for > 5 minutes
AND seizures
OR hypotonia
OR Stage 3.2
AND multiple organ dysfunction (cardiovascular, GI, hematologic, pulmonary or renal)
3.03 with shock Stage 1.01-3.02
AND shock:
4.00 with death Stage 2.01-3.03
AND death
STAGE 2.01-2.02 + GROUP
RESP_FAIL;
DX 77084, 77087;
STAGE 1.01-3.01 + (DX 79901);
DX 7682-7689;
STAGE 2.01-3.02 + (GROUP
SHOCKC OR GROUP SHOCKN) ;
DX 7680-7681;
References:
Academy of Pediatrics. Use and abuse of the Apgar score. Pediatrics. 1996; 98(1):141-142.
Hansen T, Corbet A. Disorders of transition. In: Taeusch HW and Ballard RA, eds. Avery's Diseases of the Newborn. 7th ed. Philadelphia, PA: WB Saunders; 1998:602-629.
Kliegman RM. Respiratory tract disorders. In: Behrman RE, Kliegman RM, Arvin AM, Nelson WE, eds. Nelson Textbook of Pediatrics. 15th ed. Philadelphia, PA: WB Saunders;
1996:476-490.
Liley HG, Stark AR. Respiratory distress syndrome/hyaline membrane disease. In: Cloherty JP and Stark AR, eds. Manual of Neonatal Care. 4th ed. Philadelphia, PA: Lippincott-
Raven; 1998:329-336.
Thursday, January 07, 2010 9:22:59 AM
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