Disease staging: CliniCal anD CoDeD Criteria - HCUP

Clinical Criteria with Description, Diagnostic Findings and ICD-9-CM codes
DXCat Number: SKN04
MultiStage: No
DXCat Label: Immunologically Mediated Blistering Skin Diseases Specificity: A
Etiology: Immune
Stage Description Diagnostic findings ICD-9-CM Codes
1.01 Cicatricial pemphigoid Whitish eroded and scarred lesions or blistering lesions of mucosa (dermatology report)
DX 69460, 69461;
AND subepithelial and subepidermal blistering (pathology report)
AND perilesional tissue with deposits of IgG IgA and C3 in basement membranes
1.02 Epidermolysis bullosa ecquisita
(direct and indirect immunofluorescence report)
Blisters on hands and feet
NO;
OR blisters on elbows
OR blisters on knees
OR blisters on oral mucosa with erosion
OR blisters on the sites exposed to minor trauma
AND healed with scarring milia and hyperpigmentation (dermatology report)
AND subepidermal blister (pathology report)
AND perilesional tissue with deposits of IgG, IgA, IgM and C3 in basement
membrane zone (immunofluorescent test report)
1.03 Linear IgA bullous dermatosis Linear IgA disease childhood and adult type [operative/pathology report]
OR Pruritic and burning papulovesicular, hemorrhagic, urticarial, and erosive lesions on
perineum, trunk, face, extremities and mucosa (dermatology report)
OR linear deposits of IgA in the epidermal basement membrane zone (direct
immunofluorescent microscopy report of normal perilesional skin)
AND circulating IgA autoantibodies against 285 Kda and 97/120 kDa antigens in
normal epidermal basement membrane [operative/pathology report]
1.04 Dermatitis herpetiformis Symmetric grouped papulovesicular and urticarial lesion on extensor surface of extremities,
buttocks, trunk and scalp
AND No mucosal involvement (dermatology report)
OR Dermatitis herpetiformis [operative/pathology report]
OR granular deposits of IgA in the papillary dermis and along the epidermal
basement membrane zone (direct immunofluorescent test report)
OR gluten enteropathy [operative/pathology report]
AND lymphoma [operative/pathology report]
1.05 Pemphigoid gestationis or herpes
gestationis
Pruritic polymorphic skin lesions beginning around umbilicus and spreading to abdomen and legs
(dermatology report)
OR pregnancy
AND 48 hours after delivery with linear deposits of C3 in the epidermal basement
membrane zone (direct and indirect immunofluorescent tests)
1.06 Bullous pemphigoid Blister formation of flexor surfaces of arms, legs, trunk and oral mucosa (dermatology report)
OR eosinophil rich blisters in supraepidermal regions (pathology report)
OR linear deposits of IgG and C3 in the subepidermal basement membrane zone (direct and
indirect immunofluorescent tests)
DX 6948, 6949;
DX 6940, 6942;
NO;
DX 6945;
Thursday, January 07, 2010 9:23:17 AM
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