PSI-17: Birth Trauma
Is anyone reviewing PSI-17? I recently began reviewing as our rate is high. at our facility, CDI does not typically review OB/newborns so this is new for me. So far, all of the cases have been for coded cases of 'facial bruising'. It appears that this is being coded when it is part of the assessment after delivery. It seems inappropriate that this should be resulting in a PSI.
I looked for guidance regarding the coding of birth injuries and the only relevant coding clinic I found is very old. CC1994Q1p8
Insignificant conditions or signs or symptoms that resolve without treatment are not coded.
Example: At the time of initial examination an infant is noted to have acrocyanosis, molding of the scalp and facial bruising from the birth process. Later, a nurse notes a fine rash and states that the infant initially had some problem sucking. All of these conditions are resolved or are resolving by discharge. There has been no workup or treatment given for any of these conditions. Unless the physician lists them as definitive diagnoses, do not assign codes for these conditions. See also the Second Quarter Coding Clinic 1989, page 14.
However, I don't see anything in I-10...
Does anyone have any additional information about when/under what circumstances a birth injury should be coded. I am especially interested in any resources I can bring back to our coders.
thanks!
Katy
Comments
From: https://www.qualityindicators.ahrq.gov/Downloads/Modules/PSI/V60-ICD10/TechSpecs/PSI_17_Birth_Trauma_Rate–Injury_to_Neonate.pdf
The only possible one I see is P154 - Birth Injury to Face. The only includes I see for that from the code book is "Facial Congestion".
I do not think P154 includes incidental facial bruising (all 9 of my wee ones had it, all 9 were never treated!)
Good question!
Mark
The intent of the PSI is for real injuries like facial fractures, lacerations, injuries that the hospital could conceivably control or prevent.
Mark
Hi Mark!
They are coding P15.4.
This is such a normal condition, it seems inappropriate....
Mark
Yes, I am in discussion with the coding manager now. I just wish there was some concrete guidance because they are uncomfortable not coding if the MD documents it.
May submit to coding clinic....
This is relevant as an example of how/when to code select conditions.
VOLUME 3 FOURTH QUARTER
NUMBER 4 2016, Page 60
Congenital Sacral DimpleA new code that describes a congenital sacral dimple (Q82.6) has been created at the request of the American Academy of Pediatrics to uniquely identify this condition. Congenital sacral dimples are indentations in the skin of the lower back. They are a relatively common condition in neonates which may be benign in nature. However, sacral dimples with accompanying nearby tuft of hair or certain types of skin discoloration may indicate a serious underlying abnormality of the spine or spinal cord such as spina bifida or tethered cord syndrome. It is appropriate to code congenital anomalies when identified by the provider, since they can have implications for further evaluation.
Coding advice or code assignments contained in this issue effective with discharges October 1, 2016.Katy: I just sent you something pertinent from the AHA ICD-10 Coding Handbook which I can't paste here.
Mark
Thanks Mark and Paul,
this has been very helpful. Just going to go over this stuff and hopefully do some coding education
Definitely in agreement with everything said. We currently aren't reviewing this particular PSI, but I went back and looked at ones flagged since 10/2015 and I only found one that appeared to be true "birth injury". Keep us posted Katy, I am sure with a little education everything will straighten out.
Jeff
Thanks Karen and Jeff! I really appreciate your input. Working on getting these rebilled now
Katy
I do review all PSI via the AHRQ software each month. We had the same issue! It took some coding education-they are now using P54.5 "neonatal cutaneous hemorrhage" POA, which is NOT triggering the PSI. I also asked the physicians to use that terminology as well. It's pretty silly.
Cari
At Cooper CDI is responsible for review of all PSIs / HACs and we have been able to overturn >50% consistently either by coding correction or clarification. We removed over 60% last year. We have been extremely successful with PSI 17 because it seems that just about anything is coded as an injury on a newborn. We've even seen diaper rash (described as excoriation to buttock) coded as a birth injury. We've decreased this PSI by >80%. Always remember that the physician has let you know it is a actual injury and relate it to the the birth process, and even then it must meet the definition for reporting an additional diagnosis: treatment, workup, etc. Just because neosporin is applied to a little scratch does not necessarily constitute a reportable diagnosis. Lets always keep perspective and think about clinical significance. Coding education has been a challenge because we have utilized contract coders, but are getting away from that as quickly as possible. Don't even get me started on PSI 4, in which POA is not an exclusion. ugh.