When the patient is made CMO prior to meeting PTOS then they are excluded. So with your patient in the ED, assuming they haven’t met the LOS requirement prior to the determination for comfort measures, then they would be excluded.If your patient was in the ED for extended time and met LOS before they went …
A man that was brought in as a pre hospital cardiac arrest. He was evaluated in ED 2 days prior for falls and weakness, was recommended to stay, but signed out AMA. EMS was called to his home for a fall. EMS witnessed seizure like activity followed by unresponsiveness and asystole. He was pronounced in the ED prior to any work up. Would this be a PTOS patient?
The patient had a new mechanism of injury (fall), and since he expired rapidly and no workup was completed, he can be captured as PTOS.
If I have a patient that falls from standing getting out of shower with a solitary hip fx, are we to include this as a PTOS patient due to the mechanism code (W18.2) and this falls out of the stated codes listed in the guidelines?
Yes, the code W18.2 is not in the exclusion list and so would meet PTOS criteria.
I have a question about a patient that fell came into Ed and diagnosed with L4 compression fx. Patient was given pain medication and sent home from ED. Three days later patient got stuck on toilet and called EMS and was then brought in and admitted for greater than 36 hours for intractable back pain with no OR’s performed. Would the second encounter be picked up as PTOS?
If this second encounter is based on the same injury due to the fall as the first encounter, you will not capture as PTOS. If there is documentation that there was a new injury mechanism (i.e. another fall), the patient would be considered for PTOS as long as there was also a diagnosis that falls …
We have a patient that was sledding with their grandchild, went to grab the child and had a twisting injury that resulted in a hip fx. Would this be in the PTOS inclusion? I don’t see a twist injury in Appendix 15.
Appendix 15 are examples for our solitary hip fracture exclusion. In order for a patient to meet this exclusion the patient must sustain a solitary hip fracture from a fall on the same level. It does not sound like from the information you provided that the patient fell. Therefore, the patient would not meet the …
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.