The most immediate barrier to widespread adoption of technology is cost despite the patient benefit from better health, and payer benefit from lower costs. Thoracocentesis pleural aspiration was performed on this patient with a pleural effusion. Measurable hospitalacquired conditions composite patient. Pediatric quality indicators a tool to help improve quality of health care for children. Furthermore, signs and symptoms of iatrogenic pneumothorax may vary on an individual basis for each patient. When is it appropriate to report code for iatrogenic pneumothorax. Aspiration is the technique of choice for iatrogenic pneumothoraces because recurrence usually is not a factor.
Coding for postprocedural pneumothorax california health. A provider administers cpr to a patient, and the patient develops a pneumothorax as a. The software provides the rate per hospital discharge. Opps treatment of new cpt and level ii hcpcs codes. Kennedy, md, ccs, discuss coding with icd10cmpcs and the effect. Effective october 1, 2015, the icd10 version 33 hospital acquired condition hac list replaced the icd9cm version 32 hac list. Pnemothorax definition of pnemothorax by medical dictionary. The user must multiply the rate obtained from the software by 1,000 to. 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. However, common practice reports the measure as per 1,000 discharges. Highmark began to systematically follow cms guidelines. Managing iatrogenic pneumothorax and chest tubes mayo clinic. Progressive iatrogenic pneumothorax from incorrectly. The composite psi includes the following component indicators.
Central venous catheterassociated bloodstream infection definition inclusion exclusion documentation that supports coding documentation opportunities 24 psi 7. Documentation and coding for patient safety indicators ahrq. Hccs list of comorbid conditions used by cms since billing software. Discharges with icd9cm code for iatrogenic pneumothorax in any. Quality measures fact sheet center for medicare and. Iatrogenic pneumothorax added to medicare hac list sonosite. Surgical or medical discharges for medicare ffs beneficiaries ages 18 years and older.
Some patients with traumatic pneumothorax have an unsealed opening in the chest wall. A subdivision of the code j93 further differentiates between spontaneous tension. 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. Pneumothorax after transbronchial needle biopsy currently there several diagnostic techniques that re used by radiologists and pulmonary physicians for lung cancer diagnostics.
The code is valid for the year 2020 for the submission of hipaacovered transactions. 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. 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. Using administrative data from pennsylvania hospitals to.
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. Iatrogenic pneumothorax cases secondary diagnosis per 1,000 surgical and medical. Synonyms for iatrogenic pneumothorax in free thesaurus. Psi 06 iatrogenic pneumothorax excludes thoracic surgery. Air continues to get into the pleural space but cannot exit. Example of automatic exclusion if a patient with an iatrogenic pneumothorax psi 6 was a patient. The national quality forum has endorsed several of these icd9cmbased indicators as qualityofcare measures. 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. I understand that this is not considered a hac, but is it still a catheter associated infection from a device.
Factors associated with inpatient thoracentesis procedure. Learn vocabulary, terms, and more with flashcards, games, and other study tools. Medicare announces new hospital acquired condition iatrogenic pneumothorax with venous catheterization. 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. Healthcare cost and utilization project hcup measure id. Iatrogenic pneumothorax excludes all trauma patients because these patients may be more susceptible to nonpreventable iatrogenic pneumothorax or may be miscoded for traumatic pneumothorax. Pneumothorax, iatrogenic, spontaneous and pneumomediastinum. 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 related to mechanical ventilation. The pleural space is a cavity formed by the two pleural membranes that line the thoracic cavity and cover the lungs.
Iap is often avoidable, and in many cases can be prevented through adherence to evidence. Central venous catheterassociated bloodstream infection xx. Iatrogenic pneumothorax aha coding clinic for icd10cm and. 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. Psi 6 iatrogenic pneumothorax rate, per 1,000 admissions 4,901 22,964,667 0. Identifying primary spontaneous pneumothorax from administrative. This is a concept that exists in icd9cm, but there is no exact match in icd10who. Iatrogenic pneumothorax synonyms, iatrogenic pneumothorax.
Pneumothorax occurs in 12% of all neonates, with a higher incidence in infants with neonatal respiratory distress syndrome. The latter included cases in which the pneumothorax was spontaneous but not iatrogenic. 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. Traumatic pneumothorax results from penetratingblunt trauma or iatrogenic secondary to thoracentesis, central venous line placement or lung biopsy. Patients with clinically significant pneumothorax are typically managed with evacuation via a percutaneously placed catheter or chest tube. An iatrogenic pneumothorax occurs when air enters the pleural space during a medical treatment or procedure, such as mr. Iatrogenic pneumothorax secondary to insertion of a port. Please feel free to use this information at your convenience. 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. Hospital checklist for improving documentation and coding. 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. For claims with a date of service on or after october 1, 2015, use an. After invasive procedures such as this, a chest xray should be requested, specifically to check for a.
Reduction in iatrogenic pneumothorax journal of hospital. Iatrogenic pneumothorax rate qualifying discharges with any secondary icd10cm diagnosis codes for iatrogenic pneumothorax. I understand the guideline for chapter 17, injury and poisoning 800999. Refer to tables for details on the ppc group and level for each ppc. Free health information management enewsletters hcpro. A pneumothorax can be the consequence of instrumentation of the chest. How to manage traumatic pneumothorax bsava2012 vin. Document the etiology of pneumothorax spontaneous or congenital versus. If a patient with an iatrogenic pneumothorax psi 6 was a patient. The healthcare cost and utilization project hcup tools and products to support health services research and policy analysis agency for healthcare research and quality. Pdf the link between clinically validated patient safety. 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.
Chest xray pneumothorax gallery iatrogenic pneumothorax. Challenges and remediation for patient safety indicators in. Iatrogenic pneumothorax has become an increasingly recognized complication of routine outpatient procedures, such as transthoracic needle biopsies of the lung and transbronchial lung biopsies. Novel use of interventional radiology in trauma jeph. 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. Induced unintentionally in a patient by a physician. Cases of iatrogenic pneumothorax can be identified from icd9. Managing iatrogenic pneumothorax and chest tubes request pdf. An icd10who psi coding list has been developed and. Different classifications are used to describe the various types of pneumothoraxes, though two major types commonly are. Postoperative sepsis per 1,000 electivesurgery admissions of length 4 or more days, adults. An iatrogenic pneumothorax sometimes occurs during specific diagnostic or therapeutic procedures. Learn about iatrogenic pneumothorax from patients first hand experiences and trusted online health resources, including common treatments and medications.
The cms psi 90 is a weighted average of the risk and reliabilityadjusted versions i. Iatrogenic pneumothorax in medical and surgical drgs excludes cases with chest trauma, thoracic surgery, pleural effusion, lung or pleural biopsy, diaphragmatic repair, and some cardiac procedures. Adaptation of ahrq patient safety indicators for use in icd10. 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. Most patients with pneumomediastinum should be admitted and observed for signs of serious complications eg, pneumothorax, tension pneumothorax. With anylisted icd10pcs procedure codes for lung or pleural biopsy. Ultrasound serves an effective guide in chest tube placement, resulting in lower incidence of complications, including iatrogenic pneumothorax and hemorrhage 33. 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.
The discharges from these hospitals were suppressed for reporting purposes. Thoracentesis, intercostal nerve block, cannulation of a subclavian vein, and tracheostomy are other possible causes of an iatrogenic pneumothorax. The sail value model includes 10 patient safety indicators to derive an overall index value. Primary spontaneous pneumothorax psp is a disorder commonly. However, you may be unfortunate in that such is the case at your place of employment. This measure is used to assess the number of cases of iatrogenic pneumothorax per 1,000 discharges rationale. Submitted directly to cms for the cy 2019 payment determination and subsequent. 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. Iatrogenic pneumothorax iap is a complication of invasive procedures that is associated with substantial morbidity and some mortality. We recently had a case where a patient with severe chronic obstructive pulmonary disease copd was admitted for several lung lesions. This code was replaced on september 30, 2015 by its icd10 equivalent. Used especially of an infection or other complication of treatment. All registered trademarks, used in the content, are the property of.
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. Inhospital fall with hip fracture rate qualifying discharges with any secondary icd10cm diagnosis codes for hip. Documentation and coding of complications 2 learning objectives. Product of the week product of the week trivia question. The user must multiply the rate obtained from the software by 1,000. The official publication for icd9cm and icd10cmpcs coding guidelines and advice. There is not a code specific to iatrogenic pneumothorax that was. 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. The drain is pushed through the incision in a cranial direction subcutaneously to create a tunnel and then elevated perpendicular to the thoracic wall.
Please provide clarification on the reporting of code 512. Iatrogenic pneumothorax risks, symptoms and leading. Placement of chest tube with resolution of the pneumothorax. 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. Cases of iatrogenic pneumothorax can be identified from icd9cm coded data article in american journal of medical quality 253. As of spring 2016, ahrq has updated the qi software v6. The software identifies 65 ppcs in total, which can be classified into eight groups and two levels. Patient safety indicators v2019 icd10cmpcs benchmark data. Cases of iatrogenic pneumothorax can be identified from. In several cases pneumothorax pntx is induced and immediate action is needed. Pleural effusion must be clinically significant to pick up an exclusion. Because hospitals have just begun coding with icd10 codes, there are no available national data.
Cms opps rule 2016 alaska department of health and social jun 28, 2010 central line catheter associated blood stream infection. The iatrogenic pneumothorax indicator is intended to flag cases of pneumothorax caused by medical care. When compared to ir, procedures performed by medicine had approximately the same risk of iatrogenic pneumothorax irr 1. Spontaneous pneumothorax traumatic pneumothorax including occult pneumothorax ie, pneumothorax identified on computed tomography iatrogenic pneumothorax, most. Pressure ulcer, central venous catheter, postoperative pulmonary embolism or deep vein thrombosis, iatrogenic pneumothorax. For claims with a date of service on or after october 1, 2015, use an equivalent icd10cm code or codes. Hospital pharmacy reimbursement flashcards quizlet. Pneumothorax can be categorized as primary, secondary, iatrogenic or. 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. This transition affected diagnosis and inpatient procedure coding across the united states. Because of incomplete data, 3 iatrogenic pneumothoraces reported from one center were excluded. For defining iatrogenic pneumothrax psi 6, a new specific code for iatrogenic pneumothorax should be added. Iap may occur with a subclavian sc or internal jugular ij central venous. For example, a pleural or liver biopsy may cause a pneumothorax.
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. We examined the positive predictive value ppv of 3 surgical psis. This tool was updated based on test software provided by ahrq as of. Appendix 1 available in online article presents results of randomeffects poisson regression for the likelihood of iatrogenic pneumothorax. We would like to show you a description here but the site wont allow us. Iatrogenic pneumothorax query query response 23 psi 7. Pneumothorax after transbronchial needle biopsy boskovic. What should be considered in the diagnosis of pneumothorax. 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. 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. 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. Background little is known about the factors related to the development of pneumothorax following thoracentesis. Fully searchable through findacodes comprehensive search.
Agency for healthcare research and quality ahrq data source. Description normally, the pressure in the lungs is greater than the pressure in the pleural space surrounding the lungs. Catherine porto, mpa, rhia, chp executive director him. Fiscal year 2020 hospitalacquired conditions reduction. Getting credit for planned readmissions proper coding also. Without appropriate treatment, the impaired venous return can cause systemic hypotension and. Iatrogenic definition of iatrogenic by the free dictionary. The nearly 250 changes include more than a few minor descriptor revisions, but also significant code additions. Tube thoracostomy is reserved for very symptomatic patients. Widespread consensus exists that health care organizations can reduce patient injuries by improving the environment for.