Disease staging: CliniCal anD CoDeD Criteria - HCUP

Clinical Criteria with Description, Diagnostic Findings and ICD-9-CM codes
DXCat Number: PED27
MultiStage: No
DXCat Label: Prematurity: Low Birthweight Specificity: A
Etiology: Congenital
Stage Description Diagnostic findings ICD-9-CM Codes
1.01 Premature infant with low birthweight Infant born at < 38 weeks gestation
AND birthweight of < 2500g and ≥ 1500g
DX 76500, 76506-76510, 76516-
76519;
DX V3000-V392 + (DX 76500,
76506-76510, 76516-76519);
DX V2130, V2134-V2135;
2.01 and small for gestational age (intrauterine
growth retardation)
Stage 1.01
AND birthweight less than 10 th percentile for gestational age
DX 76420, 76426-76429;
STAGE 1.01 + DX 76496-76499;
DX V3000-V392 + (DX 76420,
76426-76429);
2.02 with hypocalcemia Stage 1.01-2.01
AND hypocalcemia:
2.03 with hypoglycemia Stage 1.01-2.02
AND hypoglycemia:
2.04 with hyperbilitubinemia Stage 1.01-2.03
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]
2.05 with anemia Stage 1.01-2.04
AND anemia:
STAGE 1.01-2.01 + GROUP
HYPOCALCEMIA;
STAGE 1.01-2.02 + GROUP
HYPOGLYCEMIA;
STAGE 1.01-2.03 + GROUP
HYPERBILI;
STAGE 1.01-2.04 + (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);
2.06 with apnea of prematurity Stage 1.01-2.05
AND apnea:
respiratory pause > 20 seconds
OR respiratory pause < 20 seconds
AND cyanosis
AND pallor
AND hypotonia
AND heart rate < 100 bpm
STAGE 1.01-2.05 + DX 7708;
Thursday, January 07, 2010 9:23:01 AM
©2010 Thomson Reuters. All rights reserved.