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

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

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

PDX from Trauma Diagnosis List
AND 2 additional body sites
_____________
OR
____________
PDX from 1 body site
& 1 additional body site

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

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)

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

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

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 blood
Injury to carotid artery, jugular vein, or multi vessels of head/neck

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

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

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

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

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)

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

Trauma can be classified by the affected body areas:

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

THINGS TO THINK ABOUT:

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

* Remember the detail of the docu
* 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?

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

*** 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

Hypovolemic, hemorrhagic, traumatic

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