Diagnostic Criteria. All provider claims are restricted to claims for beneficiaries with an ICD-9CM diagnosis code of 290 through 290.43; 293 through 298.9; 300 through 301.9; 302.7, 306.51 through 312.4; 312.81 through 314.9; 315.3, 315.31, 315.5, 315.8, and 315.9.
Diagnostic Criteria. 7.1.3.1. The diagnosis is to be confirmed by Histopathology; and
7.1.3.2. The same is to be confirmed by consultant Oncologist
Diagnostic Criteria. The diagnosis must be supported by the presence of criteria mentioned below:
7.2.2.1. History of typical chest pain, and
7.2.2.2. New ECG changes confirming infarction, and
7.2.2.3. Significant elevation of cardiac enzyme – CK-MB or Troponin (T or I) elevation; and
7.2.2.4. The diagnosis should be confirmed by consultant cardiologist
Diagnostic Criteria. 7.6.2.1. Evidence of Irreversible organ failure / bone marrow disease and the requirement for transplant need to be confirmed as medically necessary by respective specialist consultants
Diagnostic Criteria. 7.8.2.1. The diagnosis must be confirmed by a consultant Neurologist
Diagnostic Criteria. There is no single laboratory test or sign which will diagnose RA. The diagnosis relies on a thorough history and examination in combination with laboratory and radiological findings. Until recently the most widely used criteria used to differentiate RA from other inflammatory arthritides were the 1987 American College of Rheumatology (ACR) diagnostic criteria. [Xxxxxx et al. 1988] (Table 1.1) These have recently been updated to allow earlier diagnosis of disease and include the anti-cyclic citrullinated peptide (anti-CCP) antibody [Aletaha et al. 2010]. (Table 1.2)
1. Morning Stiffness Morning stiffness in and around the joints, lasting at least 1 hour before maximal improvement
2. Arthritis of 3 or more joint areas At least 3 joint areas simultaneously have had soft tissue swelling or fluid (not bony overgrowth alone) observed by a physician. The 14 possible areas are right or left PIP, MCP, wrist, elbow, knee, ankle, and MTP joints
3. Arthritis of hand joints At least 1 area swollen (as defined above) in a wrist, MCP, or PIP joint
4. Symmetric arthritis Simultaneous involvement of the same joint areas (as defined in 2) on both sides of the body (bilateral involvement of PIPs, MCPs, or MTPs is acceptable without absolute symmetry)
5. Rheumatoid nodules Subcutaneous nodules, over bony prominences, or extensor surfaces, or in juxta-articular regions, observed by a physician
6. Serum rheumatoid factor Demonstration of abnormal amounts of serum rheumatoid factor by any method for which the result has been positive in <5% of normal control subjects
7. Radiographic changes Radiographic changes typical of rheumatoid arthritis on posteroanterior hand and wrist radiographs, which must include erosions or unequivocal bony decalcification localized in or most marked adjacent to the involved joints (osteoarthritis changes alone do not qualify) Target population (Who should be tested?): Patients who: 1) have at least 1 joint with definite clinical synovitis (swelling) 2) with the synovitis not better explained by another disease Classification criteria for RA (score-based algorithm: add score of categories A–D; a score of ≥6/10 is needed for classification of a patient as having definite RA)
A. Joint involvement
B. Serology (at least 1 test result is needed for classification)
C. Acute-phase reactants (at least 1 test result is needed for classification)
Diagnostic Criteria. The focus of the service should be directed to functional impairments related to an Included Diagnosis.
Diagnostic Criteria. Severity Level Medical Verification Requirements
Diagnostic Criteria. Severity Level Medical Verification Requirements B0 to B4 Chest CT or X-ray finding supporting such diagnosis, such as bibasilar reticular abnormalities (e.g., increased interstitial markings, honey-combing, hazy opacifications that are worse in the subpleural and inferior regions) with or without ground glass opacities or a lung biopsy that supports said diagnosis. Source: ATS/ERS Criteria for Diagnosis of Idiopathic Pulmonary Disease in Absence of Surgical Lung Biopsy
Diagnostic Criteria. Severity Level Criteria
