Disease staging: CliniCal anD CoDeD Criteria - HCUP

Clinical Criteria with Description, Diagnostic Findings and ICD-9-CM codes
DXCat Number: TRA07
MultiStage: No
DXCat Label: Laceration: Esophagus Specificity: A
Etiology: Trauma
Stage Description Diagnostic findings ICD-9-CM Codes
1.01 Laceration of the esophagus Laceration of the esophagus [upper endoscopy report]
DX 53089, 86222, 86232;
2.01 with acute bleeding Stage 1.01
DX 5307;
AND bleeding:
STAGE 1.01 + DX 53082;
OR Mallory-Weiss syndrome [tear distal esophagus by upper endoscopy report]
2.02 with perforation including spontaneous Stage 1.01-2.01
DX 5304;
perforation (Boerhaave's syndrome) AND subcutaneous or mediastinal emphysema [physical exam or chest x-ray report]
STAGE 1.01-2.01 + (DX 33811,
OR free air in the peritoneal cavity [KUB x-ray or chest x-ray report]
33821, 5181, 5672-5679, 9587);
OR perforation (UGI series reports spilling of contrast into the peritoneal cavity
or thoracic cavity)
2.03 with mediastinitis or mediastinal abscess or
pleurisy or hydropneumothorax
Stage 2.01-2.02
AND mediastinitis [operative/pathology report]
OR mediastinal abscess [operative/pathology report or sonogram or CT scan report]
OR pleurisy (pleural effusion culture reports growth of pathologic organism(s))
OR hydropneumothorax [chest x-ray report]
STAGE 1.01-2.02 + (DX 5110,
5118, 51189, 5131, 8600, 8601);
3.01 with sepsis Stage 2.01-2.03
AND sepsis:
3.02 with shock Stage 2.01-3.01
AND shock:
4.00 with death Stage 2.01-3.02
AND death
STAGE 1.01-2.03 + GROUP SEPSIS;
STAGE 1.01-3.01 + GROUP
SHOCKA;
NO;
References:
Duranceau A. Perforation of the esophagus. In: Sabiston, ed. Sabiston Textbook of Surgery, 15th ed. Philadelphia, PA: WB Saunders; 1997:759-767.
Goyal RK. Diseases of the esophagus. In: Fauci AS, Braunwald E, Isselbacher KJ, Wilson JD, Martin JB, Kasper DL, Hauser SL, Longo, DL, eds. Harrison’s Principles of Internal
Medicine. 14th ed. New York, NY: McGraw-Hill; 1998:796-801.
Kanowitz A, Markovchick V, Danzl, et al. Esophageal and diaphramatic trauma. In: Mosby, ed. Emergency Medicine. 4th ed. 1998:546-554.
McQuaid KR. Diseases of the esophagus: benign esophageal lesions. In: Tierney Jr LM, McPhee SJ Papadakis MA, eds. Current Medical Diagnosis & Treatment. Stamford, CT:
Appleton & Lange; 1998:565.
Rohman M, Ivatury RR. Esophagus. In: Ivatury RR, Cayten CG, eds. The Textbook of Penetrating Trauma. Philadelphia, PA: Williams & Wilkins; 1996:555-563.
Rowe MI, O’Neill JA, Grosfeld JL, Fonkalsrud EW, Coran AG. Esophageal rupture and perforation. In: Mosby, ed. Essentials of Pediatric Surgery. Philadelphia, PA. 1995:419-421.
Scherer LR III. Thoracic trauma. In: Oldham KT, Colombani PM, Foglia RP, eds. Surgery of Infants and Children. Philadelphia, PA: Lippincott-Raven, 1997:455-461.
Watson DCT. Oesophagus. In: Enis BW, ed. H Bailey’s Emergency Surgery, 12th ed. 1995:295-301.
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