Disease staging: CliniCal anD CoDeD Criteria - HCUP

Clinical Criteria with Description, Diagnostic Findings and ICD-9-CM codes
DXCat Number: RES15
MultiStage: Yes
DXCat Label: Pneumonia: Bacterial Specificity: A
Etiology: Infection, Bacterial
Stage Description Diagnostic findings ICD-9-CM Codes
1.01 Pneumonia in one lobe Pneumonia:
DX 481, 4820-4822, 48230-48239,
4824-48249, 48281-48283, 48289-
4829, 485-486;
2.01 with bacteremia Stage 1.01
AND bacteremia:
2.02 with epiglottitis Stage 1.01-2.01
AND H. influenza pneumonia [sputum c/s report or blood c/s report]
AND epiglottitis
2.03 with empyema Stage 1.1-2.2
AND empyema [thoracentesis report or effusion culture reports growth of
pathologic organism(s)]
2.04 with lung abscess or bronchopleural fistula Stage 1.01-2.03
or bronchopleural cutaneous fistula AND lung abscess [operative/pathology report]
OR air/fluid level [chest x-ray report]
OR air/fluid levels in pleural space [chest x-ray report]
OR cutaneous fistula [chest x-ray report and physical exam]
2.05 with diffuse involvement of multiple lobes Stage 1.01-2.04
AND lobular pneumonia in ≥ 2 lobes [chest x-ray report]
2.06 with septic arthritis Stage 1.01-2.05
AND septic arthritis:
2.07 with osteomyelitis Stage 1.01-2.06
AND osteomyelitis:
2.08 with peritonitis or subphrenic abscess Stage 1.01-2.07
AND peritonitis [operative/pathology report or peritoneal fluid culture reports growth of same
organism as pneumonia]
OR subphrenic abscess [operative/pathology report]
2.09 with pericarditis Stage 1.01-2.08
AND pericarditis:
3.01 with endocarditis Stage 1.01-2.08
AND endocarditis:
3.02 with meningitis Stage 1.01-3.01
AND meningitis:
3.03 with congestive heart failure Stage 1.01-3.02
AND congestive heart failure:
STAGE 1.01 + GROUP
BACTEREMIA;
DX 4822 + DX 46430;
STAGE 1.01-2.02 + DX 5109;
STAGE 1.01-2.02 + DX 5119;
STAGE 1.01-2.03 + (DX 5100,
5130);
NO;
STAGE 1.01-2.04 + GROUP
ARTHR_SEPTIC;
STAGE 1.01-2.06 + GROUP
OSTEOMYELIT;
STAGE 1.01-2.07 + (DX 5670-
5679, 56983);
STAGE 1.01-2.08 + (DX 4200,
42091-42099);
STAGE 1.01-2.09 + GROUP
ENDOCARDITIS;
STAGE 1.01-3.01 + GROUP
MENGIT__BACT;
STAGE 2.09 + GROUP
CHF__NON_HTN;
STAGE 3.01 + GROUP
CHF__NON_HTN;
Thursday, January 07, 2010 9:23:12 AM
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