Disease staging: CliniCal anD CoDeD Criteria - HCUP

Clinical Criteria with Description, Diagnostic Findings and ICD-9-CM codes
DXCat Number: END04
MultiStage: Yes
DXCat Label: Diabetes Mellitus Type 1 Specificity: A
Etiology: Metabolic
Stage Description Diagnostic findings ICD-9-CM Codes
1.01 Type 1 diabetes mellitus Fasting plasma glucose ≥ 126 mg/dl drawn ≥ 8 hours after a meal
DX 25001, 7751;
AND ≥ 24 hours later confirmation by repeat testing
OR Casual plasma glucose ≥ 200 mg/dl
AND ≥ 24 hours later confirmation by repeat testing
OR 2 hour postprandial glucose ≥ 200 mg/dl under the World
Health Organization protocol for oral glucose tolerance test
using 75g anhydrous glucose in water
AND ≥ 24 hours later confirmation by repeat testing
OR History of Type 1 Diabetes mellitus
1.02 Symptomatic diabetes mellitus Stage 1.01
AND polyuria
OR polydypsia
OR polyphagia
1.03 with history of ketoacidosis or pancreatic Stage 1.01-1.02
islet cell antibodies
AND history of ketoacidosis
OR pancreatic islet cell antibodies [chemistry report]
2.01 with retinopathy Stage 1.01-1.03
AND microaneurysms of retinal vessels [ophthalmoscopy report]
OR retinal exudates [ophthalmoscopy report]
OR retinal hemorrhages [ophthalmoscopy report]
OR neovascularization of the retina [ophthalmoscopy report]
OR neovascularization of the iris [ophthalmoscopy report]
OR rhegmatogenous detachments [ophthalmoscopy report]
OR nonrhegmatogenous detachments [ophthalmoscopy report]
DX 25003, 25081, 25083, 25091,
25093;
NO;
DX 25051, 25053;
(DX 25051, 25053) + (DX 36100-
36107, 3612-3619, 36201-36207,
36214, 36216, 36281-36282,
36442);
2.02 with neuropathy Stage 1.01-2.01
AND gastroparesis [nuclear or radiology contrast gastric emptying time]
OR neuropathy [EMG report or physical examination]
DX 25061, 25063;
(DX 25061, 25063) + (DX 3371,
3501-3569, 3572, 3581, 5363);
2.03 with glomerulosclerosis Stage 1.01-2.02
AND glomerulosclerosis [operative/pathology report]
OR Kimmelstiel-Wilson syndrome [operative/pathology report]
OR proteinuria:
DX 25041, 25043;
(DX 25041, 25043) + (DX 5811,
58181, 5821, 587, 7910);
Thursday, January 07, 2010 9:21:24 AM
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