Algorithm for Thrombocytopenia (Case Definition Only)



EMR driven Algorithm for Non-chemotherapy related Drug-Induced Thrombocytopenia (Case Definition Only)Revision historyVersion Author(s)Date0.1Jyoti Pathak12/26/20100.2Jyoti Pathak01/19/20110.3Jyoti Pathak03/11/20110.4Jyoti Pathak04/01/20110.5Jyoti Pathak, Aref Al-Kali, Chris Chute04/13/20110.6Jyoti Pathak, Aref Al-Kali, Chris Chute04/22/20110.7Jyoti Pathak, Aref Al-Kali, Chris Chute, Abel Kho04/28/20111.0Jyoti Pathak, Aref Al-Kali, Chris Chute, Abel Kho, Josh Denny09/08/20112.0Jyoti Pathak, Aref Al-Kali, Chris Chute, Abel Kho, Josh Denny11/09/2011Inclusion Criteria for Case Definition- Blood platelet count less than 50,000 per microliterAt least two repeated measures between 1-7 days- Symptoms and signs that can “potentially indicate” thrombocytopeniaBruises that develop easilyBleeding gums or nosebleedsBloody stool or urinePetechiae –- small red or purple spots on skin or mucous membranes. This is the most “strongest” symptom of all indicating Thrombocytopenia. Ecchymoses –- purple, blue, or greenish, irregularly shaped patches of skin Subjects be prescribed and administered the following list of drugs. Note that, this list is derived from () which indicates statistically significant association of the drug with thrombocytopenia as reported in FDA’s AERS database. These drugs should be present/administered within 30 days before OR 3 days after the low platelet count.Antipsychotics/AntidepressantsProzacPaxil (Paroxetene)AbilifyLexaproWellbutrinBupropionElavilTrazedoneHaldolCelexaEffexorTriavilCymbaltaHaloperidolPhenytoinAntibioticsCephazolin IVMoxafloxacinLevaquinMaxpimeBactrimDaptomycinFlagylCiprofloxacinDiflucanDoxyclineClindamycinMacrobidCetriaxoneCefapimeLevofloxinPiperacillinRifampicinEthambutolSulfisoxazoleTrimethoprim-sulfamethoxazoleAnticonvulsantsCarbamazepineTegretolTopamaxPregabalinKeppraNeurontinGabapentinBaclofenDilatinKlonopinValproic acidAnalgesic/NarcoticASAAcetaminophenOxycodoneOxycontinUltramRoxicetAlevePercocetNaproxenIbuprofenCardiac-related drugsCorderoneBetapaceLisiniprilDiltiazemNorvascAmlodipineMavik(trandolapril)Altace (Ramipril)NifidipineValsartanDiovanRythmolAntihypertensiveHCTZLabetololOsteoporosis drugsActonelFosamaxBonivaAcid blockersReglanPrilosecZantacCimetidineTagametPepcidProtonixFamotadineRanitidineAnticoagulants/AntiplateletsWarfarinASACoumadinFragminHeparin IVPlavixClopidogrelSotalolLovenoxAbciximabEptifibatideTirofibanStatinZocorPravacholSimvastatinAtorvastatinAntiarrhythmicAmiodaroneQuinidinePenicillinAmpicillinPiperacillinOthers (these can belong to multiple classes)MagnesiumIronSamariumTamoxifenDexamethazoneSynthroidIrinotecanOxaliplatinMethotrexateExclusion Criteria for Case Definition- Check for subjects with the following ICD-9 codes:287.30 Primary thrombocytopenia unspecifiedMegakaryocytic hypoplasia287.32 Evans' syndrome287.33 Congenital and hereditary thrombocytopenic purpuraCongenital and hereditary thrombocytopeniaThrombocytopenia with absent radii (TAR) syndromeExcludes:Wiskott-Aldrich syndrome (279.12)287.39 Other primary thrombocytopenia289.84 Heparin-induced thrombocytopenia (HIT)287.31 Immune thrombocytopenic purpuraIdiopathic thrombocytopenic purpuraTidal platelet dysgenesisRecent cancer treatment with cytotoxic chemotherapy and/or radiotherapy (within 3 months). Please refer to the list of CPT codes at the bottom of this document.History or currently having HIV Infection (ICD-9 042—044)History or currently having Gaucher’s disease/Lipidoses (ICD-9 272.7)History or currently having Myelofibrosis (ICD-9 289.89)History or currently having Myelodysplastic Syndrome (MDS) (ICD-9 283.7, 283.71—283.79)History or currently having Multiple Myeloma (ICD-9 230.0x)History or currently having Cirrhosis (ICD-9 571, 571.x, 571.xx)History or currently having Leukemia (ICD-9 208, 208.x, 208.xx) History or currently having Splenomegaly (ICD-9: 759.0, 789.2) or Felty’s syndrome (714.1)History or currently having Autoimmune diseases (ICD-9: 279.4, 279.41, 279.49)Rheumatoid Arthritis (ICD-9: 714, 714.x, 714.xx)Lupus (ICD-9: 710.1)Crohn’s disease (ICD-9: 555, 555.x)Any procedure indicating blood replacement or transfusionICD-9: V58.2, 99.00—99.09CPT: 36430, 36440, 36450, 36455, 36460Sources: -- this paper provides a list of drugs to look for.CPT codes for Chemotherapy96401 Chemotherapy administration, subcutaneous or intramuscular; non-hormonal anti-neoplastic96402 Chemotherapy administration, subcutaneous or intramuscular; hormonal anti-neoplastic96405 Chemotherapy administration; intralesional, up to and including 7 lesions96406 Chemotherapy administration; intralesional, up to and more than 7 lesions96409 Chemotherapy administration; intravenous, push technique, single or initial substance/drug96411 Chemotherapy administration; intravenous, push technique, each additional substance/drug (List separately in addition to code for primary procedure)96413 Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug96415 Chemotherapy administration, intravenous infusion technique; each additional hour (List separately in addition to code for primary procedure)96416 Chemotherapy administration, intravenous infusion technique; initiation of prolonged chemotherapy infusion (more than 8 hours), requiring use of a portable or implantable pump96417 Chemotherapy administration, intravenous infusion technique; each additional sequential infusion (different substance/drug), up to 1 hour (List separately in addition to code for primary procedure)96420 Chemotherapy administration, intra-arterial, push technique96422 Chemotherapy administration, intra-arterial; infusion technique, up to 1 hour96423 Chemotherapy administration, intra-arterial, infusion technique, one to 8 hours, each additional hour 96425 Chemotherapy administration, intra-arterial; infusion technique, initiation of prolonged infusion (more than 8 hours), requiring the use of a portable or implantable pump96440 Chemotherapy administration into pleural cavity requiring thoracentesis (procedure)96446 Chemotherapy administration into peritoneal cavity via indwelling port or catheter (procedure)96450 Chemotherapy administration, into CNS (eg, intrathecal), requiring and including spinal puncture96542 Chemotherapy injection, subarachnoid or intraventricular via subcutaneous reservoir, single or multiple agents96549 Unlisted chemotherapy procedure61517Implt brain chemotx add-on96400Chemotherapy, sc/im96408Chemotherapy, push technique96410Chemotherapy,infusion method96412Chemo, infuse method add-on96414Chemo, infuse method add-on96445Chemotherapy, intracavitary96545Provide chemotherapy agentCPT codes for Radiotherapy77371 Radiation treatment delivery, stereotactic radiosurgery (SRS), complete course of treatment of cranial lesion(s) consisting of 1 session; multi-source Cobalt 60 based77372 Radiation treatment delivery, stereotactic radiosurgery (SRS), complete course of treatment of cranial lesion(s) consisting of 1 session; linear accelerator based77373 Stereotactic body radiation therapy, treatment delivery, per fraction to 1 or more lesions, including image guidance, entire course not to exceed 5 fractions77401 Radiation treatment delivery, superficial and/or ortho voltage77402 Radiation treatment delivery, single treatment area, single port or parallel opposed ports, simple blocks or no blocks; up to 5 MeV77403 Radiation treatment delivery, single treatment area, single port or parallel opposed ports, simple blocks or no blocks; 6-10 MeV77404 Radiation treatment delivery, single treatment area, single port or parallel opposed ports, simple blocks or no blocks; 11-19 MeV77406 Radiation treatment delivery, single treatment area, single port or parallel opposed ports, simple blocks or no blocks; 20 MeV or greater77407 Radiation treatment delivery, two separate treatment areas, three or more ports on a single treatment area, use of multiple blocks; up to 5 MeV77408 Radiation treatment delivery, two separate treatment areas, three or more ports on a single treatment area, use of multiple blocks; 6-10 MeV77409 Radiation treatment delivery, two separate treatment areas, three or more ports on a single treatment area, use of multiple blocks; 11-19 MeV77411 Radiation treatment delivery, two separate treatment areas, three or more ports on a single treatment area, use of multiple blocks; 20 MeV or greater77412 Radiation treatment delivery, three or more separate treatment areas, custom blocking, tangential ports, wedges, rotational beam, compensators, electron beam; up to 5 MeV77413 Radiation treatment delivery, three or more separate treatment areas, custom blocking, tangential ports, wedges, rotational beam, compensators, electron beam; 6-10 MeV77414 Radiation treatment delivery, three or more separate treatment areas, custom blocking, tangential ports, wedges, rotational beam, compensators, electron beam; 11-19 MeV77416 Radiation treatment delivery, three or more separate treatment areas, custom blocking, tangential ports, wedges, rotational beam, compensators, electron beam; 20 MeV or greater77417 Therapeutic radiology port film(s)77418 ?Intensity modulated treatment delivery, single or multiple fields/arcs, via narrow spatially and temporally modulated beams, binary, dynamic MLC, per treatment session77421 Stereoscopic X-ray guidance for localization of target volume for the delivery of radiation therapy 77422 High energy neutron radiation treatment delivery; single treatment area using a single port or parallel-opposed ports with no blocks or simple blocking77423 High energy neutron radiation treatment delivery; 1 or more isocenter(s) with coplanar or non-coplanar geometry with blocking and/or wedge, and/or compensator(s)77520 Proton treatment delivery; simple, without compensation77522 Proton treatment delivery; simple, with compensation77523 Proton treatment delivery; intermediate77525 Proton treatment delivery; complex76950Echo guidance radiotherapy76965Echo guidance radiotherapy77263Radiation therapy planning77295Set radiation therapy field77332Radiation treatment aid(s)77333Radiation treatment aid(s)77334Radiation treatment aid(s)77427Radiation tx management, x577470Special radiation treatmentCPT codes for Hemodialysis 90935 Hemodialysis procedure with single physician evaluation90937 Hemodialysis procedure requiring repeated evaluation(s) with or without substantial revision of dialysis prescription90940 Hemodialysis access flow study to determine blood flow in grafts and arteriovenous fistulae by an indicator method4051F Referred for an arteriovenous (AV) fistula (ESRD, CKD)4052F Hemodialysis via functioning arteriovenous (AV) fistula (ESRD)4053F Hemodialysis via functioning arteriovenous (AV) graft (ESRD)4054F Hemodialysis via catheter (ESRD) ................
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