Disease staging: CliniCal anD CoDeD Criteria - HCUP

Clinical Criteria with Description, Diagnostic Findings and ICD-9-CM codes
DXCat Number: PED21
MultiStage: No
DXCat Label: Injury: To Newborn During Delivery Specificity: A
Etiology: Trauma
Stage Description Diagnostic findings ICD-9-CM Codes
1.01 Nonspecific trauma to newborn or fetus Newborn
DX 7678-7679;
AND trauma not specified below
1.02 Caput succedaneum Newborn
DX 7671, 76719;
AND caput succedaneum (edema of the presenting portion of the scalp)
1.03 Cephalohematoma of the newborn Newborn
NO;
AND cephalohematoma
OR localized cranial periosteal hemorrhage
1.04 Soft tissue injuries of the newborn Newborn
NO;
AND bruises on face
OR bruises on torso
1.05 Linear skull fracture of the newborn Newborn
DX 7673;
AND linear skull fracture [x-ray report]
AND no associated neurological findings on physical examination
1.06 Midclavicular, humeral or femoral fractures Newborn
DX 7672;
of the newborn
AND fracture of the clavicle [x-ray report]
OR fracture of the humerus [x-ray report[
OR fracture of the femur [x-ray report]
1.07 Subgaleal hemorrhage of the newborn Newborn
DX 76711;
AND subgaleal hemorrhage
OR boggy feeling over the entire scalp and temporal regions
2.01 Facial nerve palsy of the newborn Newborn
AND drooping of the mouth
OR flattened nasolabial fold
OR widening of the palpebral fissure
AND decreased movement of one side of the face
2.02 Brachial plexus injuries of the newborn Newborn
AND adduction and internal rotation of the shoulder with pronation of the forearm (Erb-
Duchenne paralysis)
OR paralysis of either hand(s) (Klumpke paralysis)
OR ipsilateral ptosis and miosis
2.03 Phrenic nerve paralysis of the newborn Newborn
AND Stage 2.02
AND phrenic nerve paralysis determined by absence of diaphragm movements [fluoroscopic or
ultrasonic x-ray reports
2.04 Depressed skull fracture of the newborn Newborn
AND depressed skull fracture [x-ray report]
DX 7675;
DX 7676;
DX 7677;
NO;
Thursday, January 07, 2010 9:22:59 AM
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