Inclusion/Exclusion Archives

We have had two cases of falls with surgical wound dehiscence recently. The wound dehiscence codes do not fall into inclusion criteria ICD-10 range (T81), but we feel like we should be picking these up because they were directly related to the falls. Are we correct that they are NPTOS? Or should we be coding differently?

If they don’t have an acute injury that qualifies, they won’t get picked up as PTOS. If they have surgical dehiscence, plus additional qualifying injury, then they may meet PTOS. Your registry may still wish to include as nonPTOS.

We have a situation that we have not ran into before, so we need some guidance. An employee of ours was in the pre-op holding area (while on the clock and working) when they went into vfib arrest and fell to the ground. They struck their head and have an occipital scalp laceration with exposed fat (included ICD 10 Code) They were admitted and are an inpatient at our facility for medical reasons, but was never in the ED. They went from the pre-op to the cath lab and then to the ICU. Should we consider this patient PTOS? If so, what should I enter for scene information? Would this be considered a direct admission?

Great questions! This would meet PTOS criteria due to the inclusion of the scalp lac and the ICU stay. This would be considered a direct admission because they bypassed the ED. For scene provider you would choose walk in. Let me know if you have any more questions!

Today I have a question regarding radiology reads from our providers. Often, I get Age indeterminate when it comes to fractures, especially spines. I have reached out to our department chief about this matter. However, from a registry standpoint what is our best practice? I usually @ the injury and of course it will not code. Most of these patients are transferred to a higher level of care. Would these patients fall into the PTOS category? I currently have a case where abrasions and contusions are also listed as injuries (they don’t count). I get this frequently and would like to make sure that I do this correctly every time. So that is why I am reaching out to you for a definitive answer.

For the specific injuries noted age indeterminate, you are correct, you do not code. However, your patient may meet PTOS. If you are transferring and have not ruled out traumatic injury, they would qualify. So a patient with a mechanism, the abrasions, etc., and sending out, unless your providers are saying there is no injury, …

Continue reading “Today I have a question regarding radiology reads from our providers. Often, I get Age indeterminate when it comes to fractures, especially spines. I have reached out to our department chief about this matter. However, from a registry standpoint what is our best practice? I usually @ the injury and of course it will not code. Most of these patients are transferred to a higher level of care. Would these patients fall into the PTOS category? I currently have a case where abrasions and contusions are also listed as injuries (they don’t count). I get this frequently and would like to make sure that I do this correctly every time. So that is why I am reaching out to you for a definitive answer. “

A woman was with her husband going to radiology at our acute care facility and tripped falling from standing while hurrying to the appointment. Does this patient meet inclusion as the patient wasn’t being cared for yet and wasn’t deemed a patient in our acute care facility at the time of the fall or does the patient become a rule out based on the injury that happened on the campus of our acute care facility based on page 16 of the guidelines?

This patient would meet inclusion criteria as along as she meets the other qualifiers as well (diagnosis, length of stay…etc.) Your thinking is correct that the patient was not in active care.

Isolated hip fx – fall while arising from chair? I have a note written that a fall while getting up from a seated position that resulted in an isolated hip fx would be treated like a fall from standing and would be excluded from PTOS.

You are correct. The patient fell from a standing height (even if not fully upright) and was no longer in a seated position putting it in the exclusion criteria for solitary hip fx.

We have a question regarding the exclusion/inclusion criteria. We previously reached out for clarification on this but upon reviewing with new staff I want to ensure we are capturing this correctly. If we have a patient that is transferred in from an outside hospital is in our ED and family wants hospice/comfort care we are to be including these as PTOS as the patient was transferred in, correct? However the below statement in the guidelines on page 16 is conflicting. We think that the bolded portion contradict one another, at least that’s how we are interrupting it. A patient discharged to hospice (in-house or outside), or the equivalent (i.e.palliative care, comfort care), directly from the ED or prior to meeting any portion of the PTOS inclusion criteria are NOT to be captured as PTOS. NOTE: A patient that meets the PTOS inclusion criteria prior to the order for hospice care, or the equivalent, should be captured as PTOS. Transfer in patients who are discharged to hospice directly from the ED are not to be captured as PTOS. If the order for hospice or equivalent care is rescinded and the patient receives treatment, the patient should be captured as PTOS if the patient meets the PTOS inclusion criteria.We have a question regarding the exclusion/inclusion criteria. We previously reached out for clarification on this but upon reviewing with new staff I want to ensure we are capturing this correctly. If we have a patient that is transferred in from an outside hospital is in our ED and family wants hospice/comfort care we are to be including these as PTOS as the patient was transferred in, correct? However the below statement in the guidelines on page 16 is conflicting. We think that the bolded portion contradict one another, at least that’s how we are interrupting it.

It depends on when the determination for hospice/comfort care is made. Transfer In is a qualifier, but specifically for hospice, if the determination for hospice/comfort care is made before patient leaves the ED, the patient should be excluded. If the patient went to a ward/unit/OR/post ED destination before the hospice/comfort care was ordered, they are …

Continue reading “We have a question regarding the exclusion/inclusion criteria. We previously reached out for clarification on this but upon reviewing with new staff I want to ensure we are capturing this correctly. If we have a patient that is transferred in from an outside hospital is in our ED and family wants hospice/comfort care we are to be including these as PTOS as the patient was transferred in, correct? However the below statement in the guidelines on page 16 is conflicting. We think that the bolded portion contradict one another, at least that’s how we are interrupting it. A patient discharged to hospice (in-house or outside), or the equivalent (i.e.palliative care, comfort care), directly from the ED or prior to meeting any portion of the PTOS inclusion criteria are NOT to be captured as PTOS. NOTE: A patient that meets the PTOS inclusion criteria prior to the order for hospice care, or the equivalent, should be captured as PTOS. Transfer in patients who are discharged to hospice directly from the ED are not to be captured as PTOS. If the order for hospice or equivalent care is rescinded and the patient receives treatment, the patient should be captured as PTOS if the patient meets the PTOS inclusion criteria.We have a question regarding the exclusion/inclusion criteria. We previously reached out for clarification on this but upon reviewing with new staff I want to ensure we are capturing this correctly. If we have a patient that is transferred in from an outside hospital is in our ED and family wants hospice/comfort care we are to be including these as PTOS as the patient was transferred in, correct? However the below statement in the guidelines on page 16 is conflicting. We think that the bolded portion contradict one another, at least that’s how we are interrupting it. “

I have a patient that was in the shower and fell. Does not state slipped on soap or anything in the shower, etc. Only injury is an isolated hip fx. Ortho is saying “fall on same level”. If you have something like this and there is really no mech other than a stated fall (like as if they were standing and nothing else) but they are standing in a tub at that time, would you include this as PTOS or does this still fall in the exclusion?

Fall in (into) shower or empty bathtub is coded to W18.2XXA. This code does not fall within the solitary hip fracture exclusion; therefore, the patient should be considered for PTOS.

The “within 14 days of initial hospital encounter” – we have a patient that was admitted to an outside hospital on 8/8 (date of injury as well) and remained there until 8/27 when they were transferred to us. Since this patient was admitted at the initial facility within the 14 days of injury, this would qualify to be picked up as PTOS, correct?

That is correct! The patient meets the criteria because they were injured within 14 days of the initial hospital encounter.

If you have a patient that was seen at an outside facility was transferred out to your institution via private auto. Patient then decides to go home to eat prior to coming to your facility. Do you still consider this a transfer in?

These exact scenarios are why PTOS previously excluded transfers via private vehicle as transfer patients. However, per the current guidelines, yes, this patient would be considered a transfer in as long as the documentation supports that the patient was to go via private vehicle from the OSH to your institution.

Patient comes in to the ED and gets admitted to Med/Surg and then has an unplanned admission/transfer to the ICU. This case is odd cause the patient ultimately got discharged home in 22 hours. I’d like to confirm it doesn’t matter if they go directly from the ED to the ICU – it is any stop in the ICU that would make them PTOS appropriate. Is that correct?

That’s correct, any time in ICU (plus a qualifying diagnosis) is PTOS. Assuming your patient has a diagnosis, they would be picked up as PTOS.