Coma and GCS score in nontraumatic ICH/stroke

mycdi

I am just wondering how other hospitals are taking on the challenge of  low GCS score with coma in nontraumatic diagnosis.IE sepsis/stroke??

Documentation:GCS score of 3 (E1,V1,M1) on admission pt comatose due to nontraumatic ICH, etiology HTN, now on comfort care. (pt expired as expected and never regained consciousness)

Are you coding both GCS score and Coma for the MCC? My hospital is not they say GCS score now represents the pt based on how it is index and we no longer get to capture the MCC coma if we have  GCS to correspond in nontraumatic cases.

Any thoughts? 

 Our hospital performance metrics (mortality) for stroke and sepsis involve coma, this is no longer coded at this hospital if a GCS score is present in nontraumatic injuries.

just double checking

erinchairez@hotmail.com

This is a good question! Our Providers don't like to document "coma" however, they will document the GCS with associated breakdowns (Eyes, Verbal, Motor). Our organization and coder have been a bit reluctant to index these codes. However, time and experience has given them a more bravery approach as months have passed by. I will be curious to see if other are able to capture both the coma & GCS.

dsmith12h@aol.com

I posed the same question in the past at our facility.  I wondered at the time why "coma" wasn't being coded as a diagnosis for the GCS when both were documented.  The answer to my question was similar to the response you received.  I couldn't understand because when relating the GCS to the NIHSS stroke scale you report both the diagnosis and the scale in that instance. For BMI you report both the diagnosis and the BMI.  For pressure ulcers you report the diagnosis and the stage.  The guideline for coma scale indicates "The coma scale codes should be sequenced after the diagnosis code(s)".  We have a new process where one person is designated to reconcile our cases so I'm not sure if both are being reported now. They did begin coding both at the time I was reconciling my cases prior to the new process.

evanspx@sutterhealth.org

The diagnosis code for COMA, not further specified, is a non-specific code whereas the individual GCS codes for eyes, verbal, motor ARE specific.  Hence,  the code for COMA is not reported with the individual  GCS codes.   (not logical).

GCS is not coded unless the MD documents a diagnosis or condition relevant to the GCS.

Year:	2015
Issue:	Second Quarter
Title:	I10 Glasgow Coma Scales, p 17
Body:	VOLUME 2       SECOND QUARTER NUMBER 2       2015, Page 17   Glasgow Coma Scales   Question: Can individual Glasgow coma score (GCS) codes be assigned based on documented numeric values rather than the description of the codes (e.g., eyes open to pain, best verbal response, etc.)?   When reporting the GCS, can a total score be calculated if only individual scores are documented?   Answer: Yes, if the provider’s documentation clearly shows that the ratings are specific scores or numeric values for the Glasgow scale, it would be appropriate to report codes from categories R40.21-, R40.22- and R40.23-. These codes are used only when the individual score(s) or numeric values are documented within the health record.   Do not assign code R40.24-, Glasgow coma scale, total score, if the individual scores are documented. Assign code R40.24-, Glasgow coma scale, total score, when only the total score is documented in the medical record and not the individual score(s). The 7th character indicates when the scale was recorded. The 7th character should match for all three codes.     Coding advice or code assignments contained in this issue effective with discharges July 6, 2015
Paul Evans, RHIA, CCDS

evanspx@sutterhealth.org

MCCs that also contribute to ROM are:

GCS eye 1 & 2

GCS verbal  1 & 2

GCS Motor 1, 2, & 3.

Paul

tpeyton1

Thank you for this information - it has helped clear up a question at the facility I am at now.