Table 5.

Serious illnesses

Disease	Definition
Cancer	Diagnosis of cancer (except for non-melanoma skin cancers) Selected antineoplastic agents
Hematologic diseases	Sickle cell diagnosis, aplastic anemia
Neuromuscular diseases	Cerebral palsy, muscular dystrophy, multiple sclerosis, ALS, quadriplegia, paraplegia, hemiplegia, spinal cord injury, stroke
Chromosomal anomalies	Down’s syndrome, trisomy 13, trisomy 18, autosomal deletion syndrome and others
Other congenital anomalies-non cardiovascular	Cystic fibrosis, anencephalus, spina bifida, hydrocephalus, microcephalus, encephalocele
Congenital anomalies-cardiovascular	Common truncus, transposition great vessels, tetralogy of Fallot, common ventricle, endocardial cushion defect, pulmonary atresia, tricuspid atresia, hypoplastic left heart, coarctation of aorta, other anomalies of aorta, total anomalous pulmonary venous connection
Gastrointestinal diseases	Ulcerative colitis, Crohn’s disease Liver disease: acute and subacute necrosis of the liver, chronic liver disease and cirrhosis, hepatic encephalopathy, portal hypertension, hepatorenal syndrome, other sequelae of chronic liver disease, other disorders Hospitalization for any other liver disease: abscess of the liver, portal pyemia, hepatopulmonary syndrome, other specified disorders of the liver Acute or chronic pancreatitis
Mental retardation	Moderate to profound intellectual disability
HIV and other serious infections	Diagnosis of HIV Use of antiretroviral agents appropriate for HIV or pentamidine Hepatitis B and/or C Treatment for viral hepatitis Tuberculosis Treatment for tuberculosis
Other immunologic conditions	Immune deficiencies (deficiency of humoral immunity, deficiency of cell-mediated immunity, combined immunity deficiency, unspecified immunity deficiency)
Renal disease	Diagnosis or procedure code for dialysis or end-stage renal disease outside of the hospital
Cardio-respiratory diseases	Any diagnosis of primary pulmonary hypertension Inpatient diagnosis of chronic respiratory failure, cardio-respiratory failure, or pulmonary heart disease Tracheostomy (excluding temporary)
Organ transplant	Includes kidney, heart, lung, liver, bone marrow, and pancreas Medications: azathioprine, cyclosporine, tacrolimus (except derm preparation), mycophenolate mofetil, mycophenolate sodium, sirolimus, daclizumab, antithymocyte immune, bevacizumab, basiliximab, muromonab
Other serious illness	Hospice care Diagnosis of coma, vegetative state, debility, cachexia Total parenteral nutrition/gastrostomy Gangrene Intravenous medications outside of the hospital Severe metabolic disorders: disturbances of the amino-acid transport, disturbances of carbohydrate, mucopolysaccharidosis, other specified disorders of the metabolism