I actually had a very similar scenario; attached is the response I received
from CMS. Hope this helps.
Diane
Diane Coolidge RN
Quality Review Specialist
Community Hospital Division, Quality Assurance
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From: Sepsisgroups [mailto:[email protected]] On
Behalf Of Charity Love
Sent: Tuesday, June 28, 2016 11:49 AM
To: Greg Stanford; Veronica Tarala
Cc: [email protected]
Subject: Re: [Sepsis Groups] Sepsisgroups Digest, Vol 209, Issue 1
Would like an opinion on a specific case. I have a patient that came in
through the ED and only fit criteria for sepsis, not severe in the ED and blood
cultures were not taken prior to IV ABX administration. This patient later
became hypotensive on the floor, thus fitting the criteria for severe sepsis
since two SIRS were present at this time. Since blood cultures were not
originally taken prior to ABX administration would this still be a fallout even
if at the time the ABX were given the patient did not yet meet severe sepsis
criteria? If blood cultures are taken once we have the presentation of severe
sepsis would this fit the measure even if it would be after the first dose of
ABX was already given?
Would appreciate anyone’s input on this matter.
Thanks,
Charity Love, RN, CCRN
Sepsis Coordinator
Mount Sinai Medical Center-Infection Control
Office: (305) 674-2121 X54926
Pager: (305) 212-4041
Cell: (305) 785-4214
From: Sepsisgroups [mailto:[email protected]] On
Behalf Of Greg Stanford
Sent: Saturday, June 25, 2016 2:20 PM
To: Veronica Tarala
Cc:
[email protected]<mailto:[email protected]>
Subject: Re: [Sepsis Groups] Sepsisgroups Digest, Vol 209, Issue 1
Here you go.
On Jun 25, 2016, at 12:06 PM, Veronica Tarala
<[email protected]<mailto:[email protected]>> wrote:
Does anyone have access to an article that has the latest definition of sepsis?
On Jun 23, 2016, at 6:47 PM, Greg Stanford
<[email protected]<mailto:[email protected]>> wrote:
No. Coding should not be using a differential diagnosis. It depends on how it
is worded. “Probable”, for example, will get coded. “Possible” will not. I
have ED docs who will put everything but the kitchen sink into the differential
because they think that will justify a higher level of billing. They
frequently have a template with a huge list of differentials. And it does not
meet criteria for source of infection.
Greg Stanford, MD
Medical Director
Clinical Documentation Improvement and Outcomes
1840 Amherst Street | Winchester, Va 22601
Phone: (540) 596 4999 Cell: 540 664 5736 |
|[email protected]<mailto:[email protected]>
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I would like to understand how my peers are abstracting a particular issue. I
have a question for the group…
If you have a patient in the EC and the physician lists as part of the
differential diagnoses a UTI or PNA. Then the physician documents as his final
EC diagnosis respiratory failure, COPD with exacerbation. Then let’s say the
patient does have the clinical signs to support severe sepsis. (temp 102, Pulse
124, Respiratory failure documented and placed on vent).
Do you count the differential diagnoses of UTI and PNA as a source of infection
in this scenario?
Thanks,
Debra
Debra M. Cox, BSN, RN
STTI Member
Corporate Quality Specialist | Quality Services
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Subject
2Q16 Blood Culture collection
Discussion Thread
Response Via Email (Char Teed) 06/29/2016 11:27 AM
Diane,
For this measure:
Measures are designed to address appropriate care for the majority of cases.
There may be unique situations in which care a physician feels is appropriate
is not consistent with a measure's standardized guidelines. CMS is aware of
this and does not expect all cases will meet the measure 100% of the time as
there are instances where clinically appropriate care does not fall within the
measure's standardized guidelines.
Customer By Web Form (Diane Coolidge) 06/29/2016 11:12 AM
2Q16 Blood Culture collection:
I have a patient that was admitted for a total hip replacement. She was
medically cleared and felt fine prior to the procedure. She received a pre-op
prophylactic dose of Ancef prior to surgery. On the evening of the day of
surgery she c/o chills and developed a fever. Sepsis d/t a UTI was suspected;
criteria for severe sepsis were evident. The case has resulted in an
opportunity for improvement because blood cultures were not collected prior to
administration of the pre-op antibiotic. There was no need for blood cultures
prior to the pre-op antibiotic.
The required criteria for severe sepsis management, including an initial
lactate measurement, administration of a broad spectrum antibiotic, and blood
cultures were collected prior to the dose of Zosyn that was administered after
presentation of severe sepsis.
Could you please advise me as to how I should explain this fall out to the
provider when clearly Best Practice was followed?
Question Reference #160629-000047
Product Level 1: Measures & Data Element Abstraction
Category Level 1: Hospital Inpatient - Sepsis
Category Level 2: Blood Culture Collection Date and Time
Date Created: 06/29/2016 11:12 AM
Last Updated: 06/29/2016 11:27 AM
Status: Resolved (IP only)
Discharge Period: 10/01/2015 - 06/30/2016
[---001:001891:60732---]
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