Inclusion/Exclusion Archives

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.

We do not know what constitutes a full workup and the word “rapid” is tripping us up. In a lot of our cases, we do a workup, transfer out prior to having a diagnosis, then the receiving facility only observes and discharges. So in our mind, these would be NPTOS. I reminded the team that we cannot use the receiving facilities’ data to sway our decision.

Yes, these are the challenging cases. The idea is to exclude patients for whom your team has ruled out traumatic injury. If your team is transferring and has not ruled out injury, then include them. For example, you may not do imaging on peds patients that transfer out, the receiving facility will do it and …

Continue reading “We do not know what constitutes a full workup and the word “rapid” is tripping us up. In a lot of our cases, we do a workup, transfer out prior to having a diagnosis, then the receiving facility only observes and discharges. So in our mind, these would be NPTOS. I reminded the team that we cannot use the receiving facilities’ data to sway our decision.”

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?

The patient would be NPTOS for the second encounter. This applies to existing injury and newly identified injury attributed to the same traumatic event.

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 …

Continue reading “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?”

Scenario- a patient falls transfer to OSH from scene noted to have SDH then transferred to our hospital and is transitioned to CMO in ED and d/c to hospice. Would this be a PTOS patient?

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.

Scenario: Patient presents and is treated in patient for 5 days then passes. The patient suffered hypothermia (T68.XXXA) and abrasions (S00.81XA, S20.91XA) . would we consider this PTOS?

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 …

Continue reading “Scenario: Patient presents and is treated in patient for 5 days then passes. The patient suffered hypothermia (T68.XXXA) and abrasions (S00.81XA, S20.91XA) . would we consider this PTOS?”

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 …

Continue reading “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?”