Algorithm for Neutropenia (Case Definition Only)



EMR driven Algorithm for Non-chemotherapy-related Drug-Induced Neutropenia (Case Definition Only)Revision historyVersion AuthorDate0.1Jyoti Pathak01/19/20110.2Jyoti Pathak, Aref Al-Kali, Chris Chute04/13/20110.3Jyoti Pathak, Aref Al-Kali, Chris Chute04/22/20110.4Jyoti Pathak, Aref Al-Kali, Chris Chute, Abel Kho04/28/20110.5Jyoti Pathak, Aref Al-Kali, Chris Chute, Abel Kho, Josh Denny04/28/20111.0Jyoti 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 DefinitionA patient must have all the below:288.03, 288.00, or 288.09ANC < (1500, 1000, 500) for (mild, moderate, severe) as belowPresence of an affecting medication within 30 days before or 3 days after the low ANC count- Check for subjects with the following ICD-9 codes:288.03 Drug induced neutropeniaUse additional E code to identify drug- Absolute Neutrophil Count (ANC) measured in cells per microliter of blood:The lower limit of the reference value for ANC in adults varies in different laboratories from 1.5-1.8 109/L or 1500-1800/?L (mm3). For practical purposes, a value lower than 1500 cells/?L is generally used to define neutropenia. Age, race, genetic background, environment, and other factors can influence the neutrophil count. For example, blacks may have a lower but normal ANC value of 1000 cells/?L, with a normal or low total WBC count.Neutropenia is classified as mild, moderate, or severe, based on the ANC as follows:Mild Neutropenia: (1000 <= ANC < 1500) — mildModerate Neutropenia: (500 <= ANC < 1000) — moderate risk of infectionSevere Neutropenia: (ANC < 500) — severe risk of infectionUse or prescription of medications by subjects:The highest risk categories are antithyroid medications, macrolides, and procainamides.Antimicrobials CephalosporinsVancomycinChloramphenicolGentamicinClindamycinDoxycyclineFlucytosineNitrofurantoinNovobiocinMinocyclineGriseofulvinLincomycinMetronidazoleRifampinIsoniazidStreptomycinThiacetazoneMebendazolePyrimethamineLevamisoleRistocetinSulfonamidesChloroquineHydroxychloroquineQuinacrineEthambutolDapsoneCiprofloxacinTrimethoprimImipenem/cilastatinZidovudineFludarabineAcyclovirTerbinafineCephazolin IVMoxafloxacinLevaquinMaxpimeBactrimDaptomycinFlagylCiprofloxacinDiflucanDoxyclineClindamycinMacrobidCetriaxoneCefapimeLevofloxinAnalgesics and anti-inflammatory agentsAminopyrineDipyronePhenylbutazoneIndomethacinIbuprofenAcetylsalicylic acidDiflunisalSulindacTolmetinBenoxaprofenBarbituratesMesalazineQuinineASAAcetominophenOxycodoneOxycontinUltramRoxicetAntipsychotics, antidepressants, and neuropharmacologic agentsPhenothiazines (chlorpromazine, methylpromazine, mepazine, promazine, thioridazine, prochlorperazine, trifluoperazine, trimeprazine)ClozapineRisperidoneImipramineDesipramineDiazepamChlordiazepoxideAmoxapineMeprobamateThiothixeneHaloperidolProzacPaxil (Paroxetene)AbilifyLexaproWellbutrinBupropionElavilTrazedoneAnticonvulsantsValproic acidPhenytoinTrimethadioneMephenytoin (Mesantoin)EthosuximideCarbamazepineTegretolTopamaxPregabalinAntithyroid drugsThiouracilPropylthiouracilMethimazoleCarbimazolePotassium perchlorateThiocyanateCardiovascular drugsProcainamideCaptoprilAprindinePropranololHydralazineMethyldopaQuinidineDiazoxideNifedipinePropafenoneTiclopidineVesnarinoneCorderoneBetapaceLisiniprilAntihistaminesCimetidineRanitidineTripelennamine (Pyribenzamine)MethaphenileneThenalidineBrompheniramineMianserinMiscellaneous drugsAllopurinolColchicineAminoglutethimideFamotidineBezafibrateFlutamideTamoxifenPenicillamineRetinoic acidMetoclopramidePhenindioneDinitrophenolEthacrynic acidDichlorodiphenyltrichloroethane (DDT)CinchophenAntimonyPyrithyldioneRauwolfiaEthanolChlorpropamideTolbutamideThiazidesSpironolactoneMethazolamideAcetazolamideIVIGLevodopaActonelFosamaxBonivaReglanPrilosecMagnesiumIronSamariumHCTZHeavy metals include gold, arsenic, and mercury.Exclusion Criteria for Case Definition - Check for subjects with the following ICD-9 codes:288.01 Congenital neutropeniaCongenital agranulocytosisInfantile genetic agranulocytosisKostmann's syndrome288.02 Cyclic neutropeniaCyclic hematopoiesisPeriodic neutropenia288.04 Neutropenia due to infectionRecent treatment with chemotherapy and/or radiotherapy (within 3 months).Don’t exclude based on all cancers unless actively treatedPlease refer to the list of CPT codes at the bottom of the document.Current or past history of hematologic malignancy History or currently having Myeloid Leukemia (ICD-9 205, 205.x, 205.xx)History or currently having Myelodysplastic Syndrome (MDS) (ICD-9 283.7, 283.71—283.79)History or currently having Leukemia (ICD-9 208, 208.x, 208.xx) History or currently having Aplastic anemia (ICD-9 284.x, 284.xx)History or currently having Idiopathic Thrompocytopenia Purpura (ICD-9 287.31)History or current having Arsenic poisoning (ICD-9 985.1)History or currently having Vitamin B12 deficiency (ICD-9 266.2). Active hemodialysis (defined as within 3 months beforehand)Please refer to the list of CPT codes at the bottom of the document.History or currently having Splenomegaly (ICD-9: 759.0, 789.2)Concurrent infections (within 3 months beforehand or 1 month afterwards)History or currently suffering from Sepsis (ICD-9 code: 995.91)History or currently suffering from a septic shock (ICD-9 code: 785.52)History or currently suffering from SIRS (ICD-9 code: 995.90)Sources: 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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