Diagnostic Criteria Sample Clauses

Diagnostic Criteria a. All provider claims are restricted to claims for Enrollees 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.
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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) Table 1:1 1987 ACR Criteria for the Classification of Rheumatoid Arthritis Criterion Definition
Diagnostic Criteria. Severity Level Medical Verification Requirements A0 & A1 Physician Diagnosis of Qualifying Injury in the COPD disease group. A2 to A4 Spirometry tests: Post-bronchodilator FEV1/FVC ≤0.7 (≤70%) (use post-BD when possible; otherwise, use pre-BD value) Source: European Respiratory Society/American Thoracic Society COPD Guidelines – 2005 OR For Emphysema only, a CT Scan that states as a conclusion any or all of the following: Emphysema (panlobular, panacinar or paraseptal), Bullous disease, or giant bullae; provided, however, that conclusions on a CT Scan reflecting mild or minor emphysematous changes, air-trapping, pneumatoceles, cysts or cystic disease, and/or bronchiectasis shall not qualify.
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 Medical Verification Requirements C0 & C1 Physician Diagnosis of Qualifying Injury in the Asthma/RADS disease group. C2 to C4 Pulmonary Function Test (PFT): Pre-bronchodilator FEV1 of <80% predicted, and Post-bronchodilator FEV1 improvement of 12% or 250 cc; OR Positive Methacholine Challenge Test (MCT): ≥20% decrease in FEV1 at or below 8 mg/ml Sources: Global Initiative for Asthma/World Health Organization; American College of Chest Physicians Consensus Statement
Diagnostic Criteria. Severity Level Medical Verification Requirements D0 & D1 Physician Diagnosis of Qualifying Injury in the Laryngitis/Pharyngitis disease group. D2 & D3 Physical examination or endoscopy, including Laryngoscopy or Pharyngoscopy finding redness, inflammation and/or swelling of pharyngeal or laryngeal mucosal membranes.
Diagnostic Criteria. Severity Level Medical Verification Requirements
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Diagnostic Criteria. Severity Level Criteria F0 to F2 Physician Diagnosis of a Qualifying Injury in the Upper Digestive disease group.
Diagnostic Criteria. Level Criteria H0 to H2 Death of the Primary Plaintiff established by a certificate, hospital notes, or other authoritative document (e.g., physician letter) confirming death.
Diagnostic Criteria. Level Criteria I0 to I3 Histopathology report documenting pre-cancerous or cancerous condition; OR Physician documentation of diagnosis of or treatment for pre-cancerous or cancerous condition.
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