trauma room

FAQ Category Archives:

If a patient expires in the ED after order for comfort measures only and terminal extubation, does that meet the hospice exclusion in the manual?

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 …

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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.

If the laceration /skin tear requires no treatment such as suturing is it PTOS? If no repair needed would it be considered superficial? ( which is excluded)

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. …

Continue reading “If the laceration /skin tear requires no treatment such as suturing is it PTOS? If no repair needed would it be considered superficial? ( which is excluded)”

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.

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.