PSI 8 Help! Why are we triggering this indicator?
This case falls into the numerator of PSI 8 and we cannot understand why. PSI 8 indicates that the patient had an In Hospital fall with a Hip Fracture. The patient was an elective admission for Right Total Hip Replacement. The hip was flexed and rotated to dislocate it and during that maneuver a crack was heard. The patient sustained a right distal femur fracture which was repaired with plate and screws in addition to the hip replacement. The surgeon attributed the fracture to poor bone quality during routine surgical exposure and osteoporosis. A code of M80851A (Other osteoporosis with current pathological fracture) and M9689 (Other intraoperative and postprocedural complications of Musculoskeletal System) were assigned. The code M80851A pulls this case into PSI 8. How is that fair if the intent of the measure is to report patients who fall in the hospital and fracture a hip? Is there anything we are coding incorrectly? Or this is an inherent error in the algorithm and how CMS calculates this measure that we are forced to accept even though this patient didn't fall. Thank you
Comments
I was curious, so I wrote to them, here is their answer (the email address is the one I used):
Discharges, among cases meeting the inclusion and exclusion rules for the denominator, with any secondary ICD-10-CM diagnosis codes for hip fracture(M80.051A, M80.052A, M80.059A, M80.851A, M80.852A, M80.859A) will meet the numerator criteria for PSI 08, unless the ICD-10-CM diagnosis code for hip fracture is considered present on admission. Any listed ICD-10-CM diagnosis code of M96.6- or M96.8-, is not sufficient to meet the critieria for denominator exclusion.PSI 08 is constructed to include acute fractures and exclude many fracture causes that are not likely due to fall.
The numerator contains acute fracture ICD-10-CM diagnosis codes, but it does not contain codes beginning with M96 (among others) that indicate post-procedural fracture. When other causes are eliminated, the numerator is those discharges most likely to be due to an in-hospital fall. There is no ICD-10-CM diagnosis code that can be used to indicate in-hospital fall. AHRQ has determined based on a review of discharges that the measure is accurate in identifying in-hospital fall through the exclusion of as many competing factors as possible. AHRQ regularly reviews the coding of the measures and always welcomes feedback from measure users. If you believe that there are exclusion criteria that should be added to the measure, please provide the details and AHRQ will review them for possible inclusion in future releases of the AHRQ QI measures.
Sincerely,
The AHRQ QI Technical Support TeamWebsite: http://www.qualityindicators.ahrq.gov/
E-mail: qisupport@ahrq.hhs.gov