Guidance related to mortality
Hello all,
Our CMO is asking me to help her understand the relationship with a patient admitted with mets to the spine who ends up dying in the facility.
The patient was admitted with mets to the spine with cord compression.
She has a history of Stage 4 Lung cancer
Her condition declined during the stay and she passed away while inpatient.
Hospice was consulted but she died prior to their arrival.
The case was final billed as a MS-DRG 542 with the mets to the spine being the principal diagnosis.
Apparently, this creates a poor mortality rating for our orthopedic service line.
Our CMO is struggling to understand why the cancer was not the principal diagnosis so as to move this out of the ortho DRG. I have done my best to explain to her that the mets to the spine was the primary reason for presenting to the facility as well as the Stage 4 Lung cancer was not treated during this admission.
I believe a more timely hospice consult would have helped to solve this dilemma.
I am seeking any other advice, opinions or ideas on how I can explain this concept more accurately.
I appreciate any thoughts you might have.
Thank you,
Lisa
Lisa Romanello,RN,BSN,FNS,CCDS
Manager, Clinical Documentation Improvement Specialist
CJW Medical Center
Quality and Compliance
804-228-6527
Our CMO is asking me to help her understand the relationship with a patient admitted with mets to the spine who ends up dying in the facility.
The patient was admitted with mets to the spine with cord compression.
She has a history of Stage 4 Lung cancer
Her condition declined during the stay and she passed away while inpatient.
Hospice was consulted but she died prior to their arrival.
The case was final billed as a MS-DRG 542 with the mets to the spine being the principal diagnosis.
Apparently, this creates a poor mortality rating for our orthopedic service line.
Our CMO is struggling to understand why the cancer was not the principal diagnosis so as to move this out of the ortho DRG. I have done my best to explain to her that the mets to the spine was the primary reason for presenting to the facility as well as the Stage 4 Lung cancer was not treated during this admission.
I believe a more timely hospice consult would have helped to solve this dilemma.
I am seeking any other advice, opinions or ideas on how I can explain this concept more accurately.
I appreciate any thoughts you might have.
Thank you,
Lisa
Lisa Romanello,RN,BSN,FNS,CCDS
Manager, Clinical Documentation Improvement Specialist
CJW Medical Center
Quality and Compliance
804-228-6527
Comments
Sue
Sue
I will try it.
Lisa
Ref. C. Clinic 3rd Qrtr. 1999. Pathological fx of vertebrae with met carcinoma. Pt. with spinal cord injury/compression due to met ca. In order to estabish the correct principal diagnosis, would need to know if the patient chart reflected the thrust of treatment was for the primary or secondary ca or the cord compression. If the patient had a bone biopsy, kyphoplasty, vertebroplasty than it will change the DRG. Not sure why the patient was admitted to orthopedics unless they planned to do a procedure for the cord compression/fracture. Hope this info is helpful.
Jolene File,RHIT,CCS,CPC-H,CCDS
Documentation Improvement Specialist-Coder
Hays Medical Center
jolene.file@haysmed.com
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Separate from the pdx question, what system do you have access to ... is in use at your facility ... to determine expected mortality risk? Do you have access to APR/DRG? University Healthsystem Consortium? something else?
Really, the CMO's concern should be what was the ROM for this patient ... were all of the relevant factors present with this patient documented to provide a strong expected mortality?
In my opinion, the strongest way to examine mortality is an observed/expected index, ie, risk adjusted perspective. With access to a tool for expected mortality you can demonstrate how this case (possibly) does NOT hurt.
Don
Lisa
Based on the information you provided, it does sound like the chart has been coded accurately.
We follow the UHC Risk Adjustment Models for our mortality patients. Under their methodology, some v codes carry significant weight in risk adjustment--such as the palliative care and DNR codes. However, 3M Consultants have told me that the DNR v code has no impact on the SOI/ROM in their calculations and methodology.
In Risk Adjustment, POA status of your diagnoses may also be significant. For UHC, only diagnoses that are POA-Y "count" (except the DNR v code, which can be POA-N). It is important to understand how sick the patient was when they were admitted; conditions that developed or were acquired during the hospitalization do not factor into some methodologies like UHC's. Thus, attention to accurate POA assignment is warranted. Also, ensure the dates on your procedure codes are correct, particularly for initiation of mechanical ventilation.
If your facility gets transfers from other hospitals or nursing homes, ensure that data is correct as this can aid in your profiling as well.
I do agree with what was said below. You do want to look at your Observed/Expected ratio. Also, it is important to know what the mean expected rate is for each MS-DRG and see how far above or below you are in relationship to that mean.
Pam Florence, RN
Thanks Tiffany Andras LPN CDI
Thibodaux Regional Medical Center
602 North Acadia Road
Thibodaux, Louisiana 70301
985-493-4593
Pam Florence, RN
Clinical Documentation Specialist
UK HealthCare
Phone: (859) 323-1236
Pager: (859) 330-8608
E-mail: paflor2@uky.edu