Discharge Disposition
Hello, hope the majority of you are warmer than I am in Indiana! I have a question that came up regarding a planned readmission for a surgical procedure and the appropriate use of the disposition (UB-81) "home with planned readmission".
In our scenario, a patient had an index admission for diverticulitis with abscess, and colovesicular fistula. Documentation by general surgery consult indicates that the patient would be discharged home and would follow-up with the surgeon as an outpatient to discuss and schedule surgery. The attending documented on the discharge summary that the patient would have surgical follow-up with planned surgical intervention.
The coder used "home, self care" (UB-01)when the index admission was coded. The patient returned for an elective hemicolectomy 17 days later. Our Case Management Director is questioning if the index admission disposition can be changed to reflect that is was a planned readmission. CDI and coding feel that there was not enough documentation by the surgeon indicating a procedure was actually planned as it was not scheduled and documentation indicated it was going to be discussed after discharge as an outpatient. As I review the disposition codes, I find myself uncertain when to use the planned readmission after an index admission. Do we use it if it is planned within 2 weeks, 30 days, 6 months? I would appreciate any insight you may have. Thanks!
Kathy Shumpert, MSN, RN
In our scenario, a patient had an index admission for diverticulitis with abscess, and colovesicular fistula. Documentation by general surgery consult indicates that the patient would be discharged home and would follow-up with the surgeon as an outpatient to discuss and schedule surgery. The attending documented on the discharge summary that the patient would have surgical follow-up with planned surgical intervention.
The coder used "home, self care" (UB-01)when the index admission was coded. The patient returned for an elective hemicolectomy 17 days later. Our Case Management Director is questioning if the index admission disposition can be changed to reflect that is was a planned readmission. CDI and coding feel that there was not enough documentation by the surgeon indicating a procedure was actually planned as it was not scheduled and documentation indicated it was going to be discussed after discharge as an outpatient. As I review the disposition codes, I find myself uncertain when to use the planned readmission after an index admission. Do we use it if it is planned within 2 weeks, 30 days, 6 months? I would appreciate any insight you may have. Thanks!
Kathy Shumpert, MSN, RN
Comments
I had sent a question to CMS regarding the dc disposition codes for planned readmission and I've attached their response.
Hope that helps!
Laura
Thank you for your question.
The readmission measures do not use discharge disposition codes to identify planned readmissions; instead, they classify readmissions as planned or unplanned based on the type of procedure and/or diagnosis codes in the second hospitalization.
Specifically, the readmission measures use the Planned Readmission Algorithm Version 3.0 to identify planned readmissions that do not count as readmissions in the 30-day readmission measures. For the details of the planned readmission algorithm as it applied to the AMI, HF, Pneumonia, COPD, Stroke, HWR, and THA/TKA readmission measures for the 2014 public reporting, please review the following three reports.
Please note admissions to a non-acute-care setting are not included in the readmission measures' calculation.
To review the planned readmission algorithm and the corresponding diagnosis or procedure category codes considered planned for each readmission measure, you may refer to the following sections posted in the individual Measure Updates and Specifications Reports which are available at: (www.qualitynet.org ) > Hospitals – Inpatient > Claims-Based Measures > Readmission Measures > Measure Methodology.
See Section 3.2.1 (pgs 15-18) and Tables PR1-PR4 in Appendix E (pgs 53-61) in the 2014 Measure Updates and Specification Report Hospital-Level 30-day Risk-Standardized Readmission Measures: AMI, HF, Pneumonia, COPD, and Stroke.
See Section 3.2.1 (pgs 13-14) and Tables PR1-PR4 in Appendix E (pgs 46-54) in the 2014 Measure Updates and Specifications Report: Hospital-Wide All-Cause Unplanned Readmission.
See Section 3.2.1 (pgs 15-16) and Tables PR1-PR4 in Appendix E (pgs 38-47) in the 2014 Procedure-Specific Readmission Measures Updates and Specifications Report: Elective Primary Total Hip Arthroplasty and/or Total Knee Arthroplasty.
CMS Readmission Measure Project Team