Disease staging: CliniCal anD CoDeD Criteria - HCUP

Clinical Criteria with Description, Diagnostic Findings and ICD-9-CM codes
DXCat Number: PED25
MultiStage: No
DXCat Label: Postmaturity Specificity: A
Etiology: Congenital
Stage Description Diagnostic findings ICD-9-CM Codes
1.01 Postmature infant Infant born > 42 week gestation
DX 7662-76622;
DX V3000-V392 + DX 7662-76622;
1.02 with large for gestational age Stage 1.01
AND birthweight greater than 90th percentile for gestational age
1.03 with small for gestational age (intrauterine
growth retardation)
Stage 1.01-1.02
AND birthweight less than 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 ≥ 8.0mg/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 1.1-2.5
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]
DX 7661;
DX V3000-V392 + DX 7661;
STAGE 1.01-1.02 + (DX 76400-
76409, 76490-76499);
STAGE 1.01-1.03 + 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
AND 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 9:23:01 AM
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