Chest trauma rib fractures, traumatic pneumothorax and related chest wall injuries coding coding for. Medicare announces new hospital acquired condition iatrogenic pneumothorax with venous catheterization. If a patient with an iatrogenic pneumothorax psi 6 was a patient. Pdf the link between clinically validated patient safety. Pleural effusion must be clinically significant to pick up an exclusion. Fiscal year 2020 hospitalacquired conditions reduction. The drain is pushed through the incision in a cranial direction subcutaneously to create a tunnel and then elevated perpendicular to the thoracic wall. Thoracocentesis pleural aspiration was performed on this patient with a pleural effusion. Appendix 1 available in online article presents results of randomeffects poisson regression for the likelihood of iatrogenic pneumothorax. Iatrogenic pneumothorax synonyms, iatrogenic pneumothorax. Measurable hospitalacquired conditions composite patient. Synonyms for iatrogenic pneumothorax in free thesaurus. This transition affected diagnosis and inpatient procedure coding across the united states.
This tool was updated based on test software provided by ahrq as of. The national quality forum has endorsed several of these icd9cmbased indicators as qualityofcare measures. The incidence of iatrogenic pneumothorax is 57 per 10,000 hospital admissions, with thoracic surgery patients excluded because pneumothorax may be a typical outcome following these surgeries. The software identifies 65 ppcs in total, which can be classified into eight groups and two levels. Agency for healthcare research and quality ahrq data source. As of spring 2016, ahrq has updated the qi software v6. Surgical or medical discharges for medicare ffs beneficiaries ages 18 years and older. There were 30 false positive cases, including 10 patients with an old history of pneumothorax or pneumothorax present on admission more than 72 hours before admission, and 20 cases of inaccurate coding. However, common practice reports the measure as per 1,000 discharges. The most immediate barrier to widespread adoption of technology is cost despite the patient benefit from better health, and payer benefit from lower costs. An icd10who psi coding list has been developed and. If, during the performance of a venous catheterization procedure, the clinician accidentally causes a pneumothorax, medicare will no longer reimburse the hospital for the extra costs of a resulting pneumothorax collapsed lung complication.
Iatrogenic pneumothorax related to mechanical ventilation. Iatrogenic pneumothorax aha coding clinic for icd10cm and. The patient went to surgery for decortication of lung due to left lung entrapment with adhesions, deep wedge resection of mass of the upper lung and left lower lobe, as well as closure of thorax fistula. Placement of chest tube with resolution of the pneumothorax. This signs and symptoms information for iatrogenic pneumothorax has been gathered from various sources, may not be fully accurate, and may not be the full list of iatrogenic pneumothorax signs or iatrogenic pneumothorax symptoms. For defining iatrogenic pneumothrax psi 6, a new specific code for iatrogenic pneumothorax should be added. Hccs list of comorbid conditions used by cms since billing software. A provider administers cpr to a patient, and the patient develops a pneumothorax as a. Description normally, the pressure in the lungs is greater than the pressure in the pleural space surrounding the lungs.
Product of the week product of the week trivia question. Pnemothorax definition of pnemothorax by medical dictionary. Fully searchable through findacodes comprehensive search. Induced unintentionally in a patient by a physician. For example, a pleural or liver biopsy may cause a pneumothorax. This code was replaced on september 30, 2015 by its icd10 equivalent.
Iap may occur with a subclavian sc or internal jugular ij central venous. Tube thoracostomy is reserved for very symptomatic patients. Please provide clarification on the reporting of code 512. Pneumothorax can be categorized as primary, secondary, iatrogenic or traumatic according to etiology. For claims with a date of service on or after october 1, 2015, use an equivalent icd10cm code or codes. Getting credit for planned readmissions proper coding also. The software provides the rate per hospital discharge. Pneumothorax, iatrogenic, spontaneous and pneumomediastinum. Cms opps rule 2016 alaska department of health and social jun 28, 2010 central line catheter associated blood stream infection. Traumatic pneumothorax results from penetratingblunt trauma or iatrogenic secondary to thoracentesis, central venous line placement or lung biopsy. Iatrogenic definition of iatrogenic by the free dictionary.
Patient safety indicators v2019 icd10cmpcs benchmark data. Aspiration is the technique of choice for iatrogenic pneumothoraces because recurrence usually is not a factor. All registered trademarks, used in the content, are the property of. A pneumothorax can be the consequence of instrumentation of the chest. Iatrogenic pneumothorax central venous catheterrelated bloodstream infections hip fracture pevte sepsis wound dehiscence accidental puncture or laceration coming in fy2016 surgical site infection ssi coming in fy2017 cdiff, mrsa addition of 1% reduction in payment for all msdrgs for hospitals. Iatrogenic pneumothorax risks, symptoms and leading. Iatrogenic pneumothorax iap is a complication of invasive procedures that is associated with substantial morbidity and some mortality. This is a concept that exists in icd9cm, but there is no exact match in icd10who. The pediatric quality indicators pdis are a set of measures that focus on childrens health care quality using routinely collected hospital discharge data as the basis for indicator specification. Quality measures fact sheet center for medicare and. The rare event of spontaneous pneumothorax leading to tension pneumothorax may be misdiagnosed as an asthma crisis or exacerbation of chronic obstructive pulmonary disease copd in. When compared to ir, procedures performed by medicine had approximately the same risk of iatrogenic pneumothorax irr 1. The leading causes of iatrogenic pneumothorax were transthoracic needle aspiration 128, subclavicular needle stick 119, thoracentesis 106, transbronchial biopsy 54, pleural biopsy 45 and positive pressure ventilation 38. Iatrogenic pneumothorax query query response 23 psi 7.
The general consensus among academics who study the validity of psis is that until coding revisions are implemented to the ahrq software, similar to those outlined at the end of our results summary section above, use of psis in public reporting and payforperformance needs to be reconsidered. Hospital pharmacy reimbursement flashcards quizlet. The discharges from these hospitals were suppressed for reporting purposes. Patients with clinically significant pneumothorax are typically managed with evacuation via a percutaneously placed catheter or chest tube. The official publication for icd9cm and icd10cmpcs coding guidelines and advice. This measure is used to assess the number of cases of iatrogenic pneumothorax per 1,000 discharges rationale. Pneumothorax after transbronchial needle biopsy boskovic. However, if air enters the pleural space, the pressure in the pleura then becomes greater.
Pneumothorax, condition in which air accumulates in the pleural space, causing it to expand and thus compress the underlying lung, which may then collapse. Please feel free to use this information at your convenience. The potential for iatrogenic lung damage requires that the drains only be placed when there is significant pneumothorax present and the lungs are therefore separated from the thoracic wall. Without appropriate treatment, the impaired venous return can cause systemic hypotension and. The pleural space is a cavity formed by the two pleural membranes that line the thoracic cavity and cover the lungs.
These indicators are widely used to reflect quality of care inside hospitals, as well as across geographic areas, to focus on potentially avoidable complications and iatrogenic events. I understand that this is not considered a hac, but is it still a catheter associated infection from a device. Using administrative data from pennsylvania hospitals to. Challenges and remediation for patient safety indicators in. Background little is known about the factors related to the development of pneumothorax following thoracentesis. Postoperative sepsis per 1,000 electivesurgery admissions of length 4 or more days, adults. Catherine porto, mpa, rhia, chp executive director him. Documentation and coding for patient safety indicators ahrq. Because of incomplete data, 3 iatrogenic pneumothoraces reported from one center were excluded. Healthcare cost and utilization project hcup measure id. There is a paucity of evidence on the association between clinically validated patient safety indicators psis and inpatient length of stay, mortality, and 30day unplanned readmission.
Pneumothorax after transbronchial needle biopsy currently there several diagnostic techniques that re used by radiologists and pulmonary physicians for lung cancer diagnostics. If a small amount of air enters the pleural space, the patient may be asymptomatic, but larger amounts of air can cause a partial or complete lung collapse. The cms psi 90 is a weighted average of the risk and reliabilityadjusted versions i. Identifying primary spontaneous pneumothorax from administrative. The healthcare cost and utilization project hcup tools and products to support health services research and policy analysis agency for healthcare research and quality. With anylisted icd10pcs procedure codes for lung or pleural biopsy. Novel use of interventional radiology in trauma jeph. An iatrogenic pneumothorax occurs when air enters the pleural space during a medical treatment or procedure, such as mr. Different classifications are used to describe the various types of pneumothoraxes, though two major types commonly are. Psi 6 iatrogenic pneumothorax rate, per 1,000 admissions 4,901 22,964,667 0. Discharges with icd9cm code for iatrogenic pneumothorax in any. It is found in the 2020 version of the icd10 clinical modification cm and can be used in all hipaacovered transactions from oct 01, 2019 sep 30, 2020.
Opps treatment of new cpt and level ii hcpcs codes. A subdivision of the code j93 further differentiates between spontaneous tension. Pediatric quality indicators a tool to help improve quality of health care for children. Iatrogenic pneumothorax rate qualifying discharges with any secondary icd10cm diagnosis codes for iatrogenic pneumothorax. Inhospital fall with hip fracture rate qualifying discharges with any secondary icd10cm diagnosis codes for hip.
Chest xray pneumothorax gallery iatrogenic pneumothorax. Primary spontaneous pneumothorax psp is a disorder commonly. For claims with a date of service on or after october 1, 2015, use an. Iatrogenic pneumothorax excludes all trauma patients because these patients may be more susceptible to nonpreventable iatrogenic pneumothorax or may be miscoded for traumatic pneumothorax. Spontaneous pneumothorax traumatic pneumothorax including occult pneumothorax ie, pneumothorax identified on computed tomography iatrogenic pneumothorax, most. Hospital checklist for improving documentation and coding. Cases of iatrogenic pneumothorax can be identified from icd9cm coded data article in american journal of medical quality 253. I understand the guideline for chapter 17, injury and poisoning 800999. The composite psi includes the following component indicators.
Reduction in iatrogenic pneumothorax journal of hospital. Learn about iatrogenic pneumothorax from patients first hand experiences and trusted online health resources, including common treatments and medications. Pneumothorax occurs in 12% of all neonates, with a higher incidence in infants with neonatal respiratory distress syndrome. Highmark began to systematically follow cms guidelines.
Most patients with pneumomediastinum should be admitted and observed for signs of serious complications eg, pneumothorax, tension pneumothorax. Refer to tables for details on the ppc group and level for each ppc. Iap is often avoidable, and in many cases can be prevented through adherence to evidence. The sail value model includes 10 patient safety indicators to derive an overall index value. We recently had a case where a patient with severe chronic obstructive pulmonary disease copd was admitted for several lung lesions. There is not a code specific to iatrogenic pneumothorax that was. Psi 06 iatrogenic pneumothorax excludes thoracic surgery. When patients with an open pneumothorax inhale, the negative intrathoracic pressure generated by inspiration causes air to flow into the lungs through the trachea and simultaneously into the intrapleural space through the chest wall defect. The iatrogenic pneumothorax indicator is intended to flag cases of pneumothorax caused by medical care. An iatrogenic pneumothorax sometimes occurs during specific diagnostic or therapeutic procedures.
Pneumothorax can be categorized as primary, secondary, iatrogenic or. Submitted directly to cms for the cy 2019 payment determination and subsequent. The user must multiply the rate obtained from the software by 1,000 to. Some patients with traumatic pneumothorax have an unsealed opening in the chest wall. Iatrogenic pneumothorax added to medicare hac list sonosite.
Tension pneumothorax is a pneumothorax causing a progressive rise in intrapleural pressure to levels that become positive throughout the respiratory cycle and collapses the lung, shifts the mediastinum, and impairs venous return to the heart. Documentation and coding of complications 2 learning objectives. How accurate is our documentation, coding, publically reported data severe patient harm elimination teams sphee teams sphee team use of 3m 360 encompass software quality department process how we put the genie ack in the ottle with use of 360 encompass how unm hospitals use 360 encompass to affect quality measures 3. The code is valid for the year 2020 for the submission of hipaacovered transactions. Learn vocabulary, terms, and more with flashcards, games, and other study tools. After invasive procedures such as this, a chest xray should be requested, specifically to check for a. Central venous catheterassociated bloodstream infection definition inclusion exclusion documentation that supports coding documentation opportunities 24 psi 7.
Used especially of an infection or other complication of treatment. Ultrasound serves an effective guide in chest tube placement, resulting in lower incidence of complications, including iatrogenic pneumothorax and hemorrhage 33. Furthermore, signs and symptoms of iatrogenic pneumothorax may vary on an individual basis for each patient. Factors associated with inpatient thoracentesis procedure. Iatrogenic pneumothorax has become an increasingly recognized complication of routine outpatient procedures, such as transthoracic needle biopsies of the lung and transbronchial lung biopsies. We examined the positive predictive value ppv of 3 surgical psis. Progressive iatrogenic pneumothorax from incorrectly. Pneumothorax definition pneumothorax is a collection of air or gas in the chest or pleural space that causes part or all of a lung to collapse. In several cases pneumothorax pntx is induced and immediate action is needed. Air continues to get into the pleural space but cannot exit. Cases of iatrogenic pneumothorax can be identified from icd9. The nearly 250 changes include more than a few minor descriptor revisions, but also significant code additions. Widespread consensus exists that health care organizations can reduce patient injuries by improving the environment for. When is it appropriate to report code for iatrogenic pneumothorax.
Because hospitals have just begun coding with icd10 codes, there are no available national data that allow hospitals to compare their measures to national benchmarks. The latter included cases in which the pneumothorax was spontaneous but not iatrogenic. The patient safety reporting system psrs is a program modeled upon the aviation safety reporting system and developed by the department of veterans affairs va and the national aeronautics and space administration nasa to monitor patient safety through voluntary, confidential reports. Iatrogenic pneumothorax secondary to insertion of a port. How to manage traumatic pneumothorax bsava2012 vin. Thoracentesis, intercostal nerve block, cannulation of a subclavian vein, and tracheostomy are other possible causes of an iatrogenic pneumothorax. Accumulation of air or gas in the pleural cavity, occurring as a result of disease or injury, or sometimes induced to collapse the lung in the. The user must multiply the rate obtained from the software by 1,000. Pressure ulcer, central venous catheter, postoperative pulmonary embolism or deep vein thrombosis, iatrogenic pneumothorax. Managing iatrogenic pneumothorax and chest tubes mayo clinic. Psi 6 iatrogenic pneumothorax per 1,000 discharges excluding obstetrical admissions and patients with chest trauma, thoracic surgery, lung or pleural biopsy, or cardiac surgery, age 18 years or older also excludes admissions specifically for iatrogenic pneumothorax, such as cases from earlier admissions or from other hospitals. What should be considered in the diagnosis of pneumothorax. We would like to show you a description here but the site wont allow us.
However, you may be unfortunate in that such is the case at your place of employment. Adaptation of ahrq patient safety indicators for use in icd10. Coding for postprocedural pneumothorax california health. Document the etiology of pneumothorax spontaneous or congenital versus. Effective october 1, 2015, the icd10 version 33 hospital acquired condition hac list replaced the icd9cm version 32 hac list. Example of automatic exclusion if a patient with an iatrogenic pneumothorax psi 6 was a patient. Pneumothorax, defined as the presence of air in the pleural space, is a serious complication of mechanical ventilation and is associated with increased morbidity and mortality1,2. Cases of iatrogenic pneumothorax can be identified from.