APPENDIX A

Condition and ICD-9-CM Code(s)Qualifiers
Asthma (493)Seen in ED only
No ambulatory visits within 1 week of admission
No steroid or adrenergic drugs dispensed as outpatient 2 weeks before hospitalization
No receipt of inhalation therapy within 1 week of admission in outpatient clinic
No outpatient consultant or specialist visit within 1 month
Gastroenteritis (008.4, 008.6, 008.8, 276, 558.9)Seen in ED only
Age >3 month
No ambulatory visits within 1 week of admission
Diabetic ketoacidosis (250.11)Seen in ED only
No ambulatory visits within 1 week of admission
No outpatient-consultant or specialist visit within 1 month
Immunizable diseases
 Measles (055)Age >12 mo and <12 y (measles preventable by vaccination)
 Pertussis (033)Age ≥7 mo (pertussis preventable by immunization)
H influenzae infection (320.0)Age >19 mo (H influenzae preventable in 1988 to 1991)
H influenzae infection (320.0)Age ≥7 mo (H influenzae preventable in 1991 to 1993)
Acute otitis media (382)Age ≥3 mo
Mastoiditis (383)Age ≥3 mo
Upper respiratory infection (460 or 465.9)Age ≥2 mo
Bronchitis (466.0)Age ≥18 mo
Urinary tract infection (599.0)Age ≥3 mo
Acute pyelonephritis (590.1-.9)Age ≥3 mo
Pelvic inflammatory disease (614)No antibiotic dispensed as outpatient 2 weeks before admission
No ambulatory visits within 4 weeks of admission
Infant readmissions* Infant readmitted within 2 weeks of date of birth
 Jaundice (773.1, 774.2, 774.3, 774.6, 774.7)
 Volume depletion (276.0)
 Hypernatremic (276.5)
 Congenital lower bowel obstruction (751.2, 751.3, 751.4, 751.5,  560.9, 777.1)
 Obstructive cardiac defects (745.0–745.1, 746.0–746.8,
 747.1–747.3)
Nausea and vomiting (779.3, 787.0–787.03)Age ≥3 mo
Burns (949.1–949.3)Age between 0 and 5 y (first-degree burn in child <5 y)
Viral meningitis (047.8 and 047.90)Age ≥2 mo
Viral syndrome (079.0)Age ≥3 mo

Clinical Specifications For Pediatric Avoidable Hospitalizations

    • * Infant readmission ICD 9-CM were developed by Lee KS, Perlman M, Ballantyne M, et al. J Pediatr 1995;127:758–766.