Exclusions and mortality

sadeluca@pcrmc.com

Good morning!  If a patient is admitted with sepsis, decided after admission to become a comfort care patient yielding a poa of no for the encounter for palliative care dx code, do these still count as a mortality just like another without the comfort care code?  Same question would be if they have a poa of no on a dnr status, would this still report as a mortality would without the dnr status?

sadeluca@pcrmc.com

I'd like to find out so that I can educate if this occurs, that those codes get in the first 25 that are reported. 

lprescott1

are you asking if the diagnosis of sepsis POA would contribute to the mortality index?

sadeluca@pcrmc.com

Actually for any diagnosis, if the patient decides to be placed on comfort care after they are admitted, I understand that Z51.5 poa of no is reported, do these cases contribute to the mortality index?  Same would go for a DNR code...do these codes weigh in on mortality indices?

aimee_van balen_61052

I think it would depend on which Mortality model you are using at your facility. Under the VIzient model the DNR and CMO codes would require a POA status of Yes to have positive mortality risk adjustment.

izusman

Z51.5 excludes cases from some mortality index calculation models, but only if it is coded with the POA indicator 'Yes', so you have to educate your coding staff. The most common mistake in assigning the correct POA indicator happens when the order for palliative care is issued in the ER before the patient was admitted. Many people assign POA indicator 'No' because the order was issued after the patient had already arrived to the hospital. The correct POA assignment is 'Yes'.

Also keep in mind that this diagnosis should be reported within first 8 diagnoses (9 if you count admitting diagnosis) because CMS still accepts only 9 diagnoses for mortality reporting.

nicole.newman

Izusman, 

Please can you point me to the source for the comment below? - thank you

Also keep in mind that this diagnosis should be reported within first 8 diagnoses (9 if you count admitting diagnosis) because CMS still accepts only 9 diagnoses for mortality reporting.

tlcarson@emhs.org

izusman said:

Z51.5 excludes cases from some mortality index calculation models, but only if it is coded with the POA indicator 'Yes', so you have to educate your coding staff. The most common mistake in assigning the correct POA indicator happens when the order for palliative care is issued in the ER before the patient was admitted. Many people assign POA indicator 'No' because the order was issued after the patient had already arrived to the hospital. The correct POA assignment is 'Yes'.

Also keep in mind that this diagnosis should be reported within first 8 diagnoses (9 if you count admitting diagnosis) because CMS still accepts only 9 diagnoses for mortality reporting.

Please post a source for this information as I am not able to locate this information that Medicare only accepts 9 diagnosis for mortality review.

tracyaboldt@gmail.com

Hello- I am also interested in the CMS resource indicating only 9 dx will count for Mortality patients? Is the same true for Readmission?  I have not heard this before and we ensure all codes are above 24 within what is submitted to the payer (not 9).  Please advise

Tracy Boldt RN BSN CCDS CDIP
Essentia  Health