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