Disease staging: CliniCal anD CoDeD Criteria - HCUP

Clinical Criteria with Description, Diagnostic Findings and ICD-9-CM codes
DXCat Number: PED26
MultiStage: No
DXCat Label: Prematurity: Extremely Low Birthweight Specificity: A
Etiology: Congenital
Stage Description Diagnostic findings ICD-9-CM Codes
2.01 Premature infant with extremely low
birthweight
Infant born at < 38 weeks gestation
AND birthweight of < 1000g
DX 76501-76503, 76511-76513;
DX V3000-V392 + (DX 76501-
76503, 76511-76513);
DX V2131-V2132;
2.02 with intrauterine growth retardation Stage 2.01
AND birthweight less than 10 th percentile for gestational age
DX 76421-76423;
STAGE 2.01 + (DX 76411-76413,
76491-76493) ;
DX V3000-V392 + DX 76421-76423;
2.03 with hypocalcemia Stage 2.01-2.02
AND hypocalcemia:
2.04 with hypoglycemia Stage 2.01-2.03
AND hypoglycemia:
2.05 with hyperbilirubinemia Stage 2.01-2.04
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]
2.06 with anemia Stage 2.01-2.05
AND anemia:
STAGE 2.01-2.02 + GROUP
HYPOCALCEMIA;
STAGE 2.01-2.03 + GROUP
HYPOGLYCEMIA;
STAGE 2.01-2.04 + GROUP
HYPERBILI;
STAGE 2.01-2.05 + (GROUP
ANEM_OTH_UN OR GROUP
ANEM_APLAST OR GROUP
ANEM_HEM_ACQ OR DXCAT
HEM03 OR DXCAT HEM05 OR
DXCAT HEM06 OR DXCAT HEM07
OR DXCAT HEM08 OR DX 2820-
2821 , 2823, 2827-2829);
2.07 with apnea of prematurity Stage 2.01-2.06
AND apnea:
respiratory pause > 20 seconds
OR respiratory pause < 20 seconds
AND cyanosis
AND pallor
AND hypotonia
AND heart rate < 100 bpm
STAGE 2.01-2.06 + DX 7708;
Thursday, January 07, 2010 9:23:01 AM
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