trauma room

If the laceration /skin tear requires no treatment such as suturing is it PTOS? If no repair needed would it be considered superficial? ( which is excluded)

It all comes down to the ICD-10-CM diagnosis code. Lacerations do typically fall within our ICD-10-CM inclusion code range. It is the superficial abrasions and contusions that are excluded. If the patient has an ICD-10-CM diagnosis code that falls within the PTOS inclusion code range AND the patient meets another portion of the criteria (i.e. […]

We’ve come up on a case that we have some unsure opinions on. We had a 21 year old patient come in after a fall from 6ft off a jump while snowboarding. Of note, he’s been complaining of back and neck pain for a few months, upon his CT scans, there were C4 and C5 fxs. However, it was also found that he has lesions throughout his spine including at the fx sites. Throughout his stay he was found to have Sarcoma. Our neurosurgeons are saying they’re pathological due to the lesions, but there’s argument that while they may have been present due to the lesions, they were probably made worse by the fall. Should these injuries be included?

No, if the injuries are due to the disease then you won’t pick it up. Another example would be osteophytes on a vertebra. You can pick up a fractured vertebra, but not a fractured osteophyte.

Patient had a fall and suffered traumatic injuries while an inpatient at a Psychiatric facility. Patient then transferred to us for management of those injuries. Is this considered an injury that occurs after hospital admission and to be considered a complication, not to be reported? Or should this patient be captured as PTOS?

If the patient is in an acute care hospital, and falls, that record won’t meet inclusion criteria. In other locations such as a SNF, residential care, or a psychiatric center that is not an acute care hospital, those do qualify for inclusion.

We have a patient who is being held in the ED awaiting a stepdown bed (she has rib fractures from a fall and admit orders for stepdown care inpatient). She is signing out AMA from the ED without ever actually making it to the stepdown. Technically she was a stepdown admit with a mechanism and an injury…which would make her a PTOS patient. However she is leaving the ED (after 14 hours) without ever going to the floor so she will look like an ED discharge to Collector. Are we NOT to be capturing her as PTOS since she never technically got admitted to an inpatient bed?

That’s correct. The patient was discharged home from the ED. She went home and did not meet LOS and so does not qualify as PTOS.In order for Stepdown or ICU to be qualifying criteria, the patient actually has to go to the unit.

Can you please clarify for me the following exclusion: An injury that occurs after hospital admission is considered a complication of medical care and should not be reported. Does this mean if an injury occurred while the patient was in the ED, it should be excluded?

Yes, if the injury occurs after the patient is in your hospital being treated, then that is not a qualifying injury. The idea is that those patients are being reviewed through another quality review in your hospital, so are not picked up for PTOS or NTDS.

I have another inclusion question for a patient I am working on. This individual came into the ED for a cat bite to their hand sustained the day before. He was subsequently admitted to the hospital for cellulitis secondary to the cat bite. Would he meet inclusion since he was only admitted for the cellulitis?

In the documentation provided, it appears to me that the mechanism of injury is cat bite. PTOS inclusion does not consider the mechanism of injury, diagnoses only. There is no specific icd-10 diagnosis code related to the bite itself, such as a laceration code. Since there is no documented diagnosis that falls within the ICD-10 […]

Please see below scenario’s, your input is appreciated. Scenario #1-If I have a patient who falls and has a tibia fx but is kept for inability to care for self and admitted for placement issues are we considering this patient a PTOS patient? Scenario #2- Patient fell dx with stroke and wrist fx but kept due to stoke do we pick this patient up as a PTOS patient?

In both of your scenarios, since the patient has a diagnosis that falls within our inclusion code range, they should be considered for PTOS. Note, they will need to meet the LOS criteria or another portion of the inclusion criteria before you confirm them as PTOS.

Pt is bedbound on hospice at home for terminal liver CA. Pt is lifted from bed to bedside commode by caretaker and aide when a “snap” was heard. Pt immediately complained of L knee pain. Upon review of films, there is a distal femur periprosthetic fx at OSH. Upon transfer in to our facility, Orthopedics determines the fx as pathological. Would being lifted be considered a traumatic mechanism?

This patient would not qualify as PTOS as the fracture is pathological. There is a separate pathologic and traumatic fracture category in ICD-10. Only traumatic fractures fall within the PTOS ICD-10 inclusion code range. Being lifted certainly could be a traumatic mechanism; however, in this situation, there was no injury.

If a patient comes in with an mechanism, is diagnosed with an injury, and the family decides to pursue comfort measures so the patient is compassionately extubated in the ED and passes, this is a NPTOS, correct?

That is correct. As long as the patient is placed on comfort care prior to leaving the ED or meeting another portion of the criteria (LOS, ICU, transfer, etc.) that patient will not be captured as PTOS due to our hospice patient exclusion. The patient in your scenario appears to meet this exclusion. As an […]