Capturing Glascow Coma Score
Needing help with some guidance on when to capture GCS scores.
Current Coding guidelines in regards to utilizing coma scale codes state: Coma scale codes can be used in conjunction with traumatic brain injury codes, acute cerebrovascular disease or sequelae of cerebral vascular disease codes. These codes may be used in any setting where this information is collected. The coma scale may also be used to assess the status of the central nervous system for other non-trauma conditions, such as monitoring patients in the ICU regardless of medical condition.
At our facility currently we do not report GCS scores on non trauma patients who are in the ICU if they are sedated, paralyzed or ventilated. We are looking to provide some clear guidance to the CDI and Coding staff on what other clinical scenarios would be appropriate to capture GCS scores on for patient's that don't meet the above mentioned clinical criteria. We have had several cases in which we feel the GCS score would be applicable to report, for example: Pt with Acute Encephalopathy GCS of 12 on admit, has a significant clinical decline, now unresponsive and a GCS of 3. They are not admitted to the ICU and they did not have a cerebral vascular event.
We are trying to create written guidance but finding this leaves lots of room for subjective interpretation in which we do not want the CDS or Coder focusing on a GCS score that wouldn't be appropriate to report. Any suggestions or feedback would be greatly appreciated on how we should go about with this type of guidance. Has anyone thought of this at their own facility? If so how did you determine which type of patients to report GCS scores on outside of the above recommended coding guideline suggestions?
Thanks for your help
Laura Roberts, BSN, RN
Current Coding guidelines in regards to utilizing coma scale codes state: Coma scale codes can be used in conjunction with traumatic brain injury codes, acute cerebrovascular disease or sequelae of cerebral vascular disease codes. These codes may be used in any setting where this information is collected. The coma scale may also be used to assess the status of the central nervous system for other non-trauma conditions, such as monitoring patients in the ICU regardless of medical condition.
At our facility currently we do not report GCS scores on non trauma patients who are in the ICU if they are sedated, paralyzed or ventilated. We are looking to provide some clear guidance to the CDI and Coding staff on what other clinical scenarios would be appropriate to capture GCS scores on for patient's that don't meet the above mentioned clinical criteria. We have had several cases in which we feel the GCS score would be applicable to report, for example: Pt with Acute Encephalopathy GCS of 12 on admit, has a significant clinical decline, now unresponsive and a GCS of 3. They are not admitted to the ICU and they did not have a cerebral vascular event.
We are trying to create written guidance but finding this leaves lots of room for subjective interpretation in which we do not want the CDS or Coder focusing on a GCS score that wouldn't be appropriate to report. Any suggestions or feedback would be greatly appreciated on how we should go about with this type of guidance. Has anyone thought of this at their own facility? If so how did you determine which type of patients to report GCS scores on outside of the above recommended coding guideline suggestions?
Thanks for your help
Laura Roberts, BSN, RN
Comments
This is a hot topic for me too- and based on this snippet and the actual definitions within the GCS codes - think about the impact of the patientʻs GCS on their care - of course, eliminate those cases of a medically-induced low GCS (would YOU want to be intubated with a GCS of 15???). -- but, otherwise, the low or declining GCS indicates SOMETHING going on in the brain - and will impact immediate medical-decision-making by the care team--- and considering that the actual code is defined as to TIME/PLACE itʻs measured, I especially want to include the EMS assessment - showing level of consciousness before ANY treatments are initiated-- an initial GCS of 10 for a diabetic patient can possibly be turned around by an amp of D50 before getting to the ED-- but that doesnt lessen the importance of that initial score --
i add them on a case-by-case basis -- and have worked with my coding team as well - thx!