EMR driven Algorithm for Non-chemotherapy-related Drug-Induced
Neutropenia (Case Definition Only)
Revision history
Version
0.1
0.2
0.3
0.4
0.5
1.0
2.0
Author
Jyoti Pathak
Jyoti Pathak, Aref
Al-Kali, Chris Chute
Jyoti Pathak, Aref
Al-Kali, Chris Chute
Jyoti Pathak, Aref
Al-Kali, Chris Chute,
Abel Kho
Jyoti Pathak, Aref
Al-Kali, Chris Chute,
Abel Kho, Josh
Denny
Jyoti Pathak, Aref
Al-Kali, Chris Chute,
Abel Kho, Josh
Denny
Jyoti Pathak, Aref
Al-Kali, Chris Chute,
Abel Kho, Josh
Denny
Date
01/19/2011
04/13/2011
04/22/2011
04/28/2011
04/28/2011
09/08/2011
11/09/2011
Inclusion Criteria for Case Definition
A patient must have all the below:
 288.03, 288.00, or 288.09
 ANC < (1500, 1000, 500) for (mild, moderate, severe) as below
 Presence 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 neutropenia
Use 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/µL (mm3). For practical
purposes, a value lower than 1500 cells/µL 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/µL, 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) — mild
Moderate Neutropenia: (500 <= ANC < 1000) — moderate risk of infection
Severe Neutropenia: (ANC < 500) — severe risk of infection
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Use or prescription of medications by subjects:
o The highest risk categories are antithyroid medications, macrolides,
and procainamides.
o Antimicrobials
 Cephalosporins
 Vancomycin
 Chloramphenicol
 Gentamicin
 Clindamycin
 Doxycycline
 Flucytosine
 Nitrofurantoin
 Novobiocin
 Minocycline
 Griseofulvin
 Lincomycin
 Metronidazole
 Rifampin
 Isoniazid
 Streptomycin
 Thiacetazone
 Mebendazole
 Pyrimethamine
 Levamisole
 Ristocetin
 Sulfonamides
 Chloroquine
 Hydroxychloroquine
 Quinacrine
 Ethambutol
 Dapsone
 Ciprofloxacin
 Trimethoprim
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Imipenem/cilastatin
Zidovudine
Fludarabine
Acyclovir
Terbinafine
Cephazolin IV
Moxafloxacin
Levaquin
Maxpime
Bactrim
Daptomycin
Flagyl
Ciprofloxacin
Diflucan
Doxycline
Clindamycin
Macrobid
Cetriaxone
Cefapime
Levofloxin
o Analgesics and anti-inflammatory agents
 Aminopyrine
 Dipyrone
 Phenylbutazone
 Indomethacin
 Ibuprofen
 Acetylsalicylic acid
 Diflunisal
 Sulindac
 Tolmetin
 Benoxaprofen
 Barbiturates
 Mesalazine
 Quinine
 ASA
 Acetominophen
 Oxycodone
 Oxycontin
 Ultram
 Roxicet
o Antipsychotics, antidepressants, and neuropharmacologic agents
 Phenothiazines (chlorpromazine, methylpromazine, mepazine,
promazine, thioridazine, prochlorperazine, trifluoperazine,
trimeprazine)
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Clozapine
Risperidone
Imipramine
Desipramine
Diazepam
Chlordiazepoxide
Amoxapine
Meprobamate
Thiothixene
Haloperidol
Prozac
Paxil (Paroxetene)
Abilify
Lexapro
Wellbutrin
Bupropion
Elavil
Trazedone
o Anticonvulsants
 Valproic acid
 Phenytoin
 Trimethadione
 Mephenytoin (Mesantoin)
 Ethosuximide
 Carbamazepine
 Tegretol
 Topamax
 Pregabalin
o Antithyroid drugs
 Thiouracil
 Propylthiouracil
 Methimazole
 Carbimazole
 Potassium perchlorate
 Thiocyanate
o Cardiovascular drugs
 Procainamide
 Captopril
 Aprindine
 Propranolol
 Hydralazine
 Methyldopa
 Quinidine
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Diazoxide
Nifedipine
Propafenone
Ticlopidine
Vesnarinone
Corderone
Betapace
Lisinipril
o Antihistamines
 Cimetidine
 Ranitidine
 Tripelennamine (Pyribenzamine)
 Methaphenilene
 Thenalidine
 Brompheniramine
 Mianserin
o Miscellaneous drugs
 Allopurinol
 Colchicine
 Aminoglutethimide
 Famotidine
 Bezafibrate
 Flutamide
 Tamoxifen
 Penicillamine
 Retinoic acid
 Metoclopramide
 Phenindione
 Dinitrophenol
 Ethacrynic acid
 Dichlorodiphenyltrichloroethane (DDT)
 Cinchophen
 Antimony
 Pyrithyldione
 Rauwolfia
 Ethanol
 Chlorpropamide
 Tolbutamide
 Thiazides
 Spironolactone
 Methazolamide
 Acetazolamide
 IVIG
 Levodopa
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Actonel
Fosamax
Boniva
Reglan
Prilosec
Magnesium
Iron
Samarium
HCTZ
o Heavy metals include gold, arsenic, and mercury.
Exclusion Criteria for Case Definition
- Check for subjects with the following ICD-9 codes:
288.01 Congenital neutropenia
Congenital agranulocytosis
Infantile genetic agranulocytosis
Kostmann's syndrome
288.02 Cyclic neutropenia
Cyclic hematopoiesis
Periodic neutropenia
288.04 Neutropenia due to infection
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Recent treatment with chemotherapy and/or radiotherapy (within 3 months).
o Don’t exclude based on all cancers unless actively treated
o Please refer to the list of CPT codes at the bottom of the document.
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Current or past history of hematologic malignancy
o History or currently having Myeloid Leukemia (ICD-9 205, 205.x,
205.xx)
o History or currently having Myelodysplastic Syndrome (MDS) (ICD-9
283.7, 283.71—283.79)
o History or currently having Leukemia (ICD-9 208, 208.x, 208.xx)
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History or currently having Aplastic anemia (ICD-9 284.x, 284.xx)
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History or currently having Idiopathic Thrompocytopenia Purpura (ICD-9
287.31)
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History or current having Arsenic poisoning (ICD-9 985.1)
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History or currently having Vitamin B12 deficiency (ICD-9 266.2).
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Active hemodialysis (defined as within 3 months beforehand)
o Please refer to the list of CPT codes at the bottom of the document.
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History or currently having Splenomegaly (ICD-9: 759.0, 789.2)
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Concurrent infections (within 3 months beforehand or 1 month afterwards)
o History or currently suffering from Sepsis (ICD-9 code: 995.91)
o History or currently suffering from a septic shock (ICD-9 code: 785.52)
o History or currently suffering from SIRS (ICD-9 code: 995.90)
Sources:
1.) http://emedicine.medscape.com/article/204821-overview
2.) http://en.wikipedia.org/wiki/Neutropenia
CPT codes for Chemotherapy
96401 Chemotherapy administration, subcutaneous or intramuscular; nonhormonal anti-neoplastic
96402 Chemotherapy administration, subcutaneous or intramuscular; hormonal
anti-neoplastic
96405 Chemotherapy administration; intralesional, up to and including 7 lesions
96406 Chemotherapy administration; intralesional, up to and more than 7 lesions
96409 Chemotherapy administration; intravenous, push technique, single or
initial substance/drug
96411 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/drug
96415 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 pump
96417 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 technique
96422 Chemotherapy administration, intra-arterial; infusion technique, up to 1
hour
96423 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 pump
96440 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 puncture
96542 Chemotherapy injection, subarachnoid or intraventricular via
subcutaneous reservoir, single or multiple agents
96549 Unlisted chemotherapy procedure
61517 Implt brain chemotx add-on
96400 Chemotherapy, sc/im
96408 Chemotherapy, push technique
96410 Chemotherapy,infusion method
96412 Chemo, infuse method add-on
96414 Chemo, infuse method add-on
96445 Chemotherapy, intracavitary
96545 Provide chemotherapy agent
CPT codes for Radiotherapy
77371 Radiation treatment delivery, stereotactic radiosurgery (SRS), complete
course of treatment of cranial lesion(s) consisting of 1 session; multi-source
Cobalt 60 based
77372 Radiation treatment delivery, stereotactic radiosurgery (SRS), complete
course of treatment of cranial lesion(s) consisting of 1 session; linear accelerator
based
77373 Stereotactic body radiation therapy, treatment delivery, per fraction to 1 or
more lesions, including image guidance, entire course not to exceed 5 fractions
77401 Radiation treatment delivery, superficial and/or ortho voltage
77402 Radiation treatment delivery, single treatment area, single port or parallel
opposed ports, simple blocks or no blocks; up to 5 MeV
77403 Radiation treatment delivery, single treatment area, single port or parallel
opposed ports, simple blocks or no blocks; 6-10 MeV
77404 Radiation treatment delivery, single treatment area, single port or parallel
opposed ports, simple blocks or no blocks; 11-19 MeV
77406 Radiation treatment delivery, single treatment area, single port or parallel
opposed ports, simple blocks or no blocks; 20 MeV or greater
77407 Radiation treatment delivery, two separate treatment areas, three or more
ports on a single treatment area, use of multiple blocks; up to 5 MeV
77408 Radiation treatment delivery, two separate treatment areas, three or more
ports on a single treatment area, use of multiple blocks; 6-10 MeV
77409 Radiation treatment delivery, two separate treatment areas, three or more
ports on a single treatment area, use of multiple blocks; 11-19 MeV
77411 Radiation treatment delivery, two separate treatment areas, three or more
ports on a single treatment area, use of multiple blocks; 20 MeV or greater
77412 Radiation treatment delivery, three or more separate treatment areas,
custom blocking, tangential ports, wedges, rotational beam, compensators,
electron beam; up to 5 MeV
77413 Radiation treatment delivery, three or more separate treatment areas,
custom blocking, tangential ports, wedges, rotational beam, compensators,
electron beam; 6-10 MeV
77414 Radiation treatment delivery, three or more separate treatment areas,
custom blocking, tangential ports, wedges, rotational beam, compensators,
electron beam; 11-19 MeV
77416 Radiation treatment delivery, three or more separate treatment areas,
custom blocking, tangential ports, wedges, rotational beam, compensators,
electron beam; 20 MeV or greater
77417 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 session
77421 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 blocking
77423 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 compensation
77522 Proton treatment delivery; simple, with compensation
77523 Proton treatment delivery; intermediate
77525 Proton treatment delivery; complex
76950 Echo guidance radiotherapy
76965 Echo guidance radiotherapy
77263 Radiation therapy planning
77295 Set radiation therapy field
77332 Radiation treatment aid(s)
77333 Radiation treatment aid(s)
77334 Radiation treatment aid(s)
77427 Radiation tx management, x5
77470 Special radiation treatment
CPT codes for Hemodialysis
90935 Hemodialysis procedure with single physician evaluation
90937 Hemodialysis procedure requiring repeated evaluation(s) with or without
substantial revision of dialysis prescription
90940 Hemodialysis access flow study to determine blood flow in grafts and
arteriovenous fistulae by an indicator method
4051F 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)