trauma room

FAQ Category Archives:

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: 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?”

Scenario- a patient falls transfer to OSH from scene noted to have SDH then transferred to AGH 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.

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.

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 …

Continue reading “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?”

We had a patient that came in as a possible suicide attempt via hanging but he really didn’t go through with it. He said he chickened out with the hanging but took pills instead. Anyway while in the ER, it was noticed that he had an old wrist lac from a previous suicide attempt via slicing his wrist but he says that he could not find anything sharp enough. We did admit him under medical services for psych eval. We do not know if the attempt with the wrist cutting was within the last 14 days or not. What are your thoughts on this being a PTOS inclusion?

There is currently no flag for the NTDB/TQIP or a check in PTOS that generates if the injury date/time is unknown regarding the 14-day requirement. Therefore, it is the default that patients with unknown injury dates and times are to be considered for inclusion. If the patient has a documented injury that falls within the …

Continue reading “We had a patient that came in as a possible suicide attempt via hanging but he really didn’t go through with it. He said he chickened out with the hanging but took pills instead. Anyway while in the ER, it was noticed that he had an old wrist lac from a previous suicide attempt via slicing his wrist but he says that he could not find anything sharp enough. We did admit him under medical services for psych eval. We do not know if the attempt with the wrist cutting was within the last 14 days or not. What are your thoughts on this being a PTOS inclusion?”