Multiple Significant Trauma

1. Multiple Significant Trauma MDC 24

2. You Don’t Know About Principles of Multiple Significant Trauma is What You Don’t Know! Objectives • Gain a practical understanding of principles governing Multiple Significant Trauma under the MS-DRG system • Recognize clinical clues, signs and symptoms of specific disease entities subject to unrecognized opportunities for clinical clarification during the chart review process • Learn how to practically apply underlying principles of Multiple Significant Trauma through use of case studies as part of the presentation Presented by; • Kathy Thomas, RN Clinical Documentation Specialist, Wheaton Franciscan Health Care – Elmbrook Memorial • Renee Hedtcke, RN, CCDS, Aurora Medical Center Summit

4. MST Surgical DRG 955 Craniotomy RW 5.4529 ALOS 11.7 956 Limb Reattachment, RW 3.6322 ALOS 8.5 hip or femur procedure 957 Other OR procedures w/ MCC RW 6.6017 ALOS 14.5 958 w/CC RW 3.7491 ALOS 9.2 959 w/o CC/MCC RW 2.4711 ALOS 5.7

5. DEFINITION OF TRAUMA Refers to "wound" body wound/shock produced by sudden physical injury from accident or violence>>>major trauma. This can result in secondary complications; 
 shock/failure/death. Treatment of the trauma patient often involves multiple 
management diagnostics and procedures

6. What Qualifies for MST PDX from Trauma Diagnosis List AND 2 additional body sites _____________ OR ____________ PDX from 1 body site & 1 additional body site

7. Trauma Diagnosis List Less severe and do not qualify as a “body site” Examples: Closed or open skull fractures with no or unspecified LOC, or w/ concussion Concussion w/ no LOC, unspecified, or LOC < 1 hr Vertebral fracture, open or closed, without spinal cord injury Rib fractures - closed, 6 or less, or unspecified Rib fractures - open, 3 or less, or unspecified Sternum, clavicle, or scapula - closed fracture

8. Trauma Diagnosis List, cont Closed Fractures of upper or lower extremity Dislocations, open or closed (except open hip, knee, ankle, shoulder, elbow) Sprains or strains Open wounds Traumatic amputation of thumb, fingers or toes (complete or partial)

9. Trauma Diagnosis List, cont Injury to blood vessels Superficial injuries Contusions Injury to nerves Complications of trauma, secondary and recurrent hemorrhage Posttraumatic wound infection NEC Injury, other and unspecified

10. Body Site Categories MST 1 Head MST 2 Chest MST 3 Abdomen MST 4 Kidney – Adrenal MST 5 Urinary – Pelvic MST 6 Pelvis – Spine MST 7 Upper Limb MST 8 Lower Limb

11. MST 1 Head LOC brief – less than 1 hr LOC or Concussion moderate 1-24 hrs prolonged, >24 hrs unspecified Intercranial injury Skull or multiple facial fractures, open or closed, w/cerebral lac intercranial hemorrhage Cerebral laceration and contusion Injury to carotid artery, jugular vein, or multi blood vessels of head/neck

12. MST 2 Chest Rib fractures: Closed, 7 or more Open, 4 or more Sternum, open fracture or open dislocation Traumatic pneumothorax or hemothorax Injury to heart and lung (heart and lung contusion) Injuries to thoracic blood vessels, subclavian veins, superior vena cava, thoracic aorta Complications of trauma, air or fat embolism

13. MST 3 Abdomen Injury with or without open wound to: Stomach, Small intestine, colon, rectum, pancreas, bile duct and gall bladder, other GI sites Injury to appendix w/o mention of open wound Injury to Liver or spleen Injury to other GI sites, without mention of open wound into cavity: ie traumatic insertion of NG tube Injury to blood vessels of the abdomen and pelvis

14. MST 4 Kidney Injury to kidney Injury to adrenal gland w/ or w/o mention of open wound MST 5 Urinary Injury to pelvic organs (bladder, urethra, ureter, uterus) [includes traumatic removal or insertion of foley]

15. MST 6 Pelvis and Spine Fracture of vertebral column, open or closed, with spinal cord injury Fracture of vertebral column, sacrum, and coccyx open or closed, without spinal cord injury Or unspecified spinal cord injury Dislocation of vertebra open, cervical open or closed Spinal cord injury w/o evidence of spinal bone injury Injury to nerve roots

16. MST 7 Upper Limb Open fractures of bones of the arm Open dislocation of shoulder or elbow Traumatic amputation of arm and hand (complete or partial) Injury to blood vessels of UE Injury to nerves (brachial plexus, axillary, median, ulnar, radial)

17. MST 8 Lower Limb Fracture of femur (open or closed) Multi fx LE w/ UE, both LE, LE w/ sternum Open dislocation of hip, knee, or ankle Traumatic amputation of foot or leg (complete or partial) Injury to femoral artery, femoral veins, popliteal or tibial blood vessels Or other specified blood vessels of LE

18. CLASSIFICATIONS

Trauma can be classified by the affected body areas:

* POLYTRAUMA (40%)
 * HEAD INJURY (30%)
 * CHEST TRAUMA (20%)
 * ABDOMINAL TRAUMA (10%)
 * EXTREMITY TRAUMA (2%)





19. THINGS TO THINK ABOUT:

If Polytrauma is 40% of injuries; why are there not more MST DRGs?

* Remember the detail of the documentation of injuries will
determine whether or not the DRG goes to MST or to another MDC 
* Use your clinical expertise >does the patient look sicker than the
documentation supports? 
* Are the results of diagnostics appropriately and clearly documented?
 * Are query opportunities identified?
 * Are suspected conditions confirmed or ruled out? * secondary conditions effecting level of care and resource consumption
documented? 






20. THINGS TO THINK ABOUT…
 * missed injury? not found during initial assessment but manifested later?
(ie: traumatic foley insertion or removal could change the DRG to MST)
 * did the patient require one or more surgical interventions? * EMT treatment/survey – life threatening injury * ED treatments/survey – Complete inspection, systemic assessment * Consults * Diagnostics: CT, Xray, MRI * Labs: Hematuria, ABG’s, CBC, Blood sugar elevation * Procedures: paracentesis, pericardiaocentesis

21. *** All injuries do not have to be POA Pt pulling out their foley causing urethral trauma, or Traumatic insertion of an NG tube causing injury. Any injury from a fall while in the hospital would not count as an MST qualifying injury. ***Additional injuries beyond qualifying for the MST DRG DO NOT count as CC/MCC’s

22. Possible CC’s with MST Acute Renal Failure Acute Blood Loss Anemia Atelectasis

23. Possible MCC’s with MST Pneumonia Respiratory Failure Respiratory Arrest Cardiac Arrest Shock – Hypovolemic, hemorrhagic, traumatic PE Quadriplegia

24. Possible Query opportunities if MST is suspected Clarify LOC and the duration Clarify the number of rib fractures If there is broken skin consider clarifying: Open or closed fractures Open or closed dislocation Laceration to underlying organ If there is a contusion/ hematoma, blood transfusion, spreading ecchymosis, drop in H/H, fractured bone consider: Injury to blood vessel Contusion or laceration to underlying organ Brain contusion (851) Heart or lung contusion (861) Injury to Liver Injury to Spleen