The patient would be NPTOS for the second encounter. This applies to existing injury and newly identified injury attributed to the same traumatic event.
Hi, we’re wondering if the following scenario should be picked up for PTOS. We had a patient come in for an MVC. She was admitted with injuries and met the LOS so was a PTOS on her first encounter. She then returned two days later and rib fxs that were not seen or addressed on her first admission were found. She was then admitted for those. They’re attributed to that initial MVC mechanism which was within two weeks. Will this second encounter be PTOS as well? We see the exclusion for returning for the same “injury mechanism” but does this apply to new unaddressed injuries as well or returning with the same injury?
We have a scenario where a patient had an orbit fracture and transfer was set up to go to an OSF. The team agreed to transfer patient for further evaluation. The patient left our ED by POV. In following up with the OSF, however, it was identified that the patient did not go to the OSF for further care. I want to record this as a transfer out – all of our records note that the patient’s disposition was OSF, via POV. However, my Coordinator wants to me to remove the transfer out disposition. PTOS status will be based on this – Can you please clarify for us?
I agree with you capturing this patient as PTOS and recording them as a transfer out since all of your documentation appears to indicate the patient was to go to the OSF via POV. Starting with 2021 admissions, the requirement for patients to go from one acute care facility to another via EMS or air …
Since this patient is a transfer in, you will include this patient as PTOS. A patient that meets the PTOS inclusion criteria prior to the order for hospice care, or the equivalent, should be captured as PTOS. If the patient would have come directly to your facility, they would have been excluded.
This is a good question. Since the abrasions are not injuries that fall within the accepted PTOS ICD-10-CM code range, this patient should be excluded from PTOS. Note the following isolated injuries are excluded from PTOS:S00, S10, S20, S30, S40, S50, S60, S70, S80, S90, *T68, T71.1 and T75.1 are excluded if no otherinjuries are …
This readmission clarification is giving us a run for our money!! I understand the definition, but I am not understanding the reason for capturing this patient population… I am about to abstract a patient that would fall into this category. ER discharge for a hand lac on 1/18. Returns 2 days later for increased pain and cellulitis. LOS is 10 days for multiple OR sessions for I&D. In the past we would not include this patient in the registry at all- so in 2022 we are to include?
The reason for this inclusion/exclusion guidance is to ensure consistency statewide. It is our hope that this guidance will eliminate hospitals making differing determinations using variables that are not part of the inclusion criteria. You only need to pick them up if they still have a qualifying injury diagnosis. If the patient has a diagnosis …
: Since this patient is a transfer in, you will include this patient as PTOS. A patient that meets the PTOS inclusion criteria prior to the order for hospice care, or the equivalent, should be captured as PTOS. If the patient would have come directly to your facility, they would have been excluded.
Would this case qualify as a PTOS patient….I’m not sure because of the location of the fall? This patient came to the ED with GI issues. The patient had been triaged and was waiting in the ED waiting room to be seen when she had a trip and fall in the ED waiting room while walking to the restroom. The fall resulted in a femur fracture and a scalp laceration. I know that if the patient was an Inpatient in our hospital resulting in a fall and a fracture that it would be excluded, but I’m not sure since at the time of the fall, she had not yet been admitted?
No, this patient won’t be PTOS if the injury happened in your hospital while they were a patient. They do not need to be officially admitted, may be in ED or observation.
If you have a patient that is a transfer and has an admission order but is discharged from the ER because of bed availability, would you have to see if the patient met the other criteria to be a PTOS or just because they were a tx in w/ an admit order makes them a PTOS regardless? I know LOS does not pertain if they do go to the floor and/or ICU but not sure about those that hold in the ER.
The current PTOS patient criteria states that patients that are transferred in but discharged home from the ED should be excluded from PTOS. Even if the patient had an admission order, this is based on physical location of the patient. The patient can be captured as PTOS if they meet another portion of the criteria …
Can you please help me understand if a person who is Osteoporotic with a traumatic mechanism and a fractured bone would be considered PTOS if they meet the other inclusion criteria? I have a trip and fall from standing landing on her knees resulting in a “supracondylar periprosthetic femur fx in an osteoporotic female”. Would this case be a PTOS?
These are tricky scenarios, and clarification is typically needed from the provider in order to make a determination. We recommend querying the provider for clarification on whether this is a traumatic or pathological fracture.
I have a patient that has an “Osteoporotic L4 burst fx” after opening a window and twisting something in her back. I just want to make sure I am thinking correctly that this would be included as a PTOS?
No, not necessarily. If they are saying this is osteoporotic, and therefore pathological, then no it wouldn’t be PTOS. That could get coded to M80.08XA, Age-related osteoporosis with current pathological fracture, vertebra OR M80.88XA, Other osteoporosis with current pathological fracture, vertebra. Neither of those two codes are in our inclusion. In order to qualify for …