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The Society of Thoracic Surgeons Frequently Asked Questions: Adult
Cardiac Surgery Database Version 2.52.1 August, 2006 How to use the interactive FAQ Document: 1. To
review all clinical questions in an individual section, click on the section
title below. |
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Section P:
seq# 2710-3010 |
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2.
To review an individual Seq# clinical question, click on the Seq# title
below. 1280 OpCAB
3090-3180 Section R. 3. CC/TM: Corrections/Clarifications to Training
Manual |
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NEW |
Date |
SeqNo |
FieldName |
Definition |
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2710 |
Comps-Complications |
Indicate whether a postoperative
complication occurred during the hospitalization for surgery. This includes
the entire postoperative period up to discharge, even if over 30 days. |
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NEW! |
Sequence #: 2710 |
No, this is not coded as a
complication of the surgery. |
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2720 |
Comps-Op-ReOp Bleed/Tamponade |
Indicate whether an operative
re-intervention was required for bleeding/tamponade. |
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2/04 |
The
STS has been informed that the standard of practice at a number of sites is
to reop patients in their ICU settings.
Please see the following clarification that pertains to seq# 2720: Include patients that return to an OR suite or equivalent OR
environment (i.e., ICU setting) as identified by your institution, that
require surgical reintervention to investigate/correct
bleeding/tamponade. Include only those
bleeding/tamponade interventions that pertain to the mediastinum or thoracic
cavity. Please note that all other
reop fields do require a return to an OR suite to capture as a complication. |
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2730 |
Comps-Op-ReOp Vlv Dys |
Indicate whether an operative re-intervention was required for valve
dysfunction. |
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2740 |
Comps-Op-ReOp Gft Occl |
Indicate whether an operative re-intervention was required for coronary
graft occlusion. |
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CC/TM |
2/04 |
In
the Training Manual, seq# 2740, Clarification Section: The reference to the seq# in the third
paragraph, seq# 4870, is incorrect and should read Seq# 2750. |
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2750 |
Comps-Op-ReOp Other Card |
Indicate whether an operative re-intervention was required for other
cardiac reasons. |
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From version 2.41 |
4/03 |
Do
AICDs and pacemakers get captured in this section? |
Only if the patient returns to the OR to have these
devices placed (which rarely happens) otherwise these procedures would not be
captured. However, if the patient had a
VTach/Fib arrest that required AICD placement, capture the arrest under section
"R", seq #5270 Comp-Other- Cardiac Arrest. If the patient did
not arrest the AICD does not get captured. If the patient was in heart
block and required a pacemaker, capture the arrhythmia under section R, seq
#5260 Comp-Other-Heart Block. |
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From version 2.41 |
11/03 |
I have a patient that had a 1 vessel bypass and AVR
procedure done, the patient was off pump, the chest was closed and they were
about to transfer, the patient did not leave the OR bed or OR suite. He then became hypotensive and had EKG changes. They reopened the chest and went back on
pump and did two more grafts. Do I
need to do another data entry or is this a complication from the first
procedure and marked as a reop for other cardiac? |
Postoperative is defined as the
time period from when the patient leaves the OR until discharge. So this scenario would not be captured in
the complications section. The
complications section comes into play once the patient leaves the OR. Since this patient did not leave the OR,
the initial one vessel/AVR procedure and the subsequent two vessel procedure
would be captured as one event, as the primary surgical procedure. |
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4/04 |
Postoperative patient returns to OR for pacemaker placement for either
heart block or atrial fibrillation. Would the pacemaker procedure
be captured under: 1.
ReOp Other Cardiac Problem, seq#
2750 2.
Either Heart Block, seq# 2930 or
Atrial Fibrillation, seq# 2990 3.
or both? |
The Database is interested in capturing anytime in the postoperative
period when a patient returns to the OR.
If the patient returns to the OR, please capture both the return visit
to the OR and the reason for the
return, if possible. We realize that
in all cases the reason for the return to the OR may not be able to be
captured because the reason is not an option to select in the Database. If the patient in your example received a pacemaker postoperatively and
did not have the pacemaker placed in the OR, but rather in the Cath lab or EP
lab, then only capture the reason for the pacemaker placement, i.e., heart
block or atrial fibrillation. Similarly, if a patient in the postoperative period
returns to the OR due to a GI bleed, both seq# 2760, Reop for Other Non
Cardiac Problem and seq# 2970, GI complication need to be captured. The one
exception to this rule is that if the patient returns to the OR for bleeding
tamponade, only seq# 2720, Reop for Bleeding/Tamponade should be coded, not
seq# 2960, Tamponade. Seq# 2960 is for
those tamponades that do not require a return to the OR, but are medically
managed. The difference being that
seq# 2720 is specific to the reason for the return to the OR, unlike seq#
2750, Reop Other Cardiac and seq# 2760, Reop Other Non Cardiac. |
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NEW! |
A patient had a CABG done in
April,06. He stayed in the hospital. Later on, he received a heart transplant
(an orthotopic heart transplant)in June, 06 because CABG didn't help. |
1) Should we code the above as 2
procedures: one for CABG and the other is for heart transplant. |
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2760 |
Comps-Op-ReOp Other Non Card |
Indicate whether operative
re-intervention was required for other non-cardiac reasons. This includes procedures requiring a return
to the operating room such as tracheostomy, hematoma evacuation, and
procedures that address the sternum.
This does not include procedures performed outside the OR such as GI
Lab for peg tube, shunts for dialysis, etc. |
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From version 2.41 |
11/03 |
The
following sternum related procedures would be captured under seq# 2760, as
long as the patient returns to the OR. 1.
to
close sternum, after sternum opened at the bedside 2.
to
close sternum, after not being able to close sternum in the OR after initial
CT procedure 3.
for
sternal dehiscence procedures 4.
repair of a broken sternal wire |
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4/04 |
We had several patients with cholelithiasis requiring lap
choleys. Would this procedure be
captured under: 1. reop for other non cardiac
(seq # 2750) 2. GI complication (seq# 2970) 3. or both? |
Please capture the cholelithiasis requiring lap choleys under both
ReOp for Other Non Cardiac and GI Complication. The Database is interested in capturing anytime in the postop period
when a patient returns to the OR. If
the patient returns to the OR, please capture both the return visit to the OR
and the reason for the return, if
possible. We realize that in all cases
the reason for the return to the OR may not be able to be captured because
the reason is not an option to select in the Database. Additional examples include: If
a patient received a pacemaker and did not have the pacemaker placed in the
OR but rather the Cath lab or EP lab, then only capture the reason for the
pacemaker placement, i.e., heart block or atrial fibrillation. Similarly, if
a patient in the postoperative period returns to the OR due to a GI bleed,
both seq# 2760, Reop for Other Non Cardiac Problem and seq# 2970, GI
complication need to be captured. The one exception to this rule is that if
the patient returns to the OR for bleeding tamponade, only seq# 2720, Reop
for Bleeding/Tamponade should be coded, not also seq# 2960, Tamponade. Seq# 2960 is for those tamponades that do
not require a return to the OR, but are medically managed. The difference being that seq# 2720 is
specific to the reason for the return to the OR, unlike seq# 2750, Reop Other
Cardiac and seq# 2760, Reop Other Non Cardiac. |
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2770 |
Comps-Op-Perioperative MI |
( 0-24 hours post-op) Indicate
the presence of a peri-operative MI ( 0-24 hours post-op) as documented by
the following criteria: The
CK-MB (or CK if MB not available) must be greater than or equal to 5 times
the upper limit of normal, with or without new Q waves present in two or more
contiguous ECG leads. No symptoms
required. (>
24 hours post-op) Indicate
the presence of a peri-operative MI (> 24 hours post-op) as documented by
at least one of the following criteria: 2.
Development of new Q- waves in two or more contiguous ECG leads 3. New
or presumably new LBBB pattern on the ECG 4. The
CK-MB (or CK if MB not available) must be greater than or equal to 3 times
the upper limit of normal Because
normal limits of certain blood tests may vary, please check with your lab for
normal limits for CK-MB and total CK. Defining
Reference Control Values (Upper Limit of Normal): Reference values must be determined in
each laboratory by studies using
specific assays with appropriate quality control, as reported in peer-reviewed
journals. Acceptable imprecision (coefficient of variation) at the 99th percentile for each assay should
be defined as < or = to 10%. Each individual laboratory should confirm the range of reference
values in their specific setting. __________________ This
element should not be coded as an adverse event for evolving MIs unless
their enzymes peak, fall, then have a second peak. |
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01/06 |
Please provide the rationale for
why we are only looking at CKMB (or CK if MB not available) as an indicator
for periprocedural MI <24 hours post op.
The definition in V2.52 is too limited in determining post op MI when
only evaluating bio markers as an indicator.
From conversations with other participants, many have chosen to not
assess biomarkers "unless clinically indicated." This has created a criteria for users to
change their plan of care in order to have better benchmark reporting, which
is not the purpose of the data base.
This definition has also created an abnormally high value in reporting
periprocedural MI's. |
At the time of the creation of
v2.52.1, Troponins were not used universally. Will consider for the next
upgrade. The complete definition for Seq# 2770 COpPerMI includes a CK of
>5 times normal (0-24hrs) with or without new Q waves and ST Elevations,
new Q waves and new LBBB (>24 hrs). |
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2780 |
Comps-Infect-Stern Deep |
Indicate whether patient had a deep
sternal infection involving muscle, bone, and/or mediastinum REQUIRING
OPERATIVE INTERVENTION. Must
have ALL of the following conditions: 1. Wound opened with excision of tissue
(I&D) or re-exploration of mediastinum 2. Positive culture 3. Treatment with antibiotics |
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NEW! |
Sequence #: 2780 |
This is not a complication recorded
for the hospital admission when the patient had his primary surgical
procedure because it is performed at another hospital. I assume this patient had surgery,
however, I do not know for sure. Also,
the surgery did not take place during his current admission with us, however,
he was scheduled for such, and then for some reason was sent to another
hospital to have this done. The
patient was started on antibiotics here; wound culture was + for serratia
marcescens, diptheroid and peptostreptococcus. A consult was made with our
infectious disease physician who stated in his consult that the patient
"had some mild wound dehiscence of his lower sternal area. The wound has subsequently cultured
positive. The patient has complicated skin and soft tissue infection
involving the sternal wound area status post open-heart surgery. CT does not show any involvement of the
sternal bone. Regardless, this patient
will need to have antibiotics for at least 4 weeks." Code the readmission as other related and
readmission procedure as muscle flap. |
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2790 |
Comps-Infect-Thoracotomy |
Indicate whether the patient had an infection involving a thoracotomy
or parasternal site. Must have one of the following conditions: 1. Wound opened with excision of
tissue (I&D) 2. Positive culture 3. Treatment with antibiotics |
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2800 |
Comps-Infect-Leg |
Indicate whether the patient an infection involving a leg vein harvest
site. Must have one of the following conditions: 1. Wound opened with excision of
tissue (I&D) 2. Positive culture 3. Treatment with antibiotics |
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2810 |
Comps-Infect-Septicemia |
Indicate whether the patient had Septicemia (requires positive blood
cultures) postoperatively. |
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9/04 |
There are times when patients do not
have positive blood cultures but everyone calls them septic. They present with fevers, hypotension and
usually MSOF. Should this be coded as septicemia? Other patients have multiple
positive blood cultures and fevers but do not experience hypotension or
MSOF. Should this be coded as septicemia? |
The definition clearly states that
a positive blood culture is required. I can not imagine someone that
has been diagnosed with septicemia not having a blood culture, but stranger
things have happened. The language in the Training Manual
for this seq# is very helpful and should be taken into consideration
prior to coding septicemia: |
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Comps-Neuro-Stroke |
Indicate whether the patient had a central neurologic deficit
persisting for > 72 hours. |
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2840 |
Comps-Neuro-Stroke Trans |
Indicate whether the patient had a transient neurologic deficit (TIA)
recovery within 24 hours; Reversible Ischemic Neurologic Deficit (RIND)
recovery within 72 hours). |
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2850 |
Comps-Neuro-Cont Coma
>=24Hrs |
Indicate whether the patient had a new
postoperative coma that persists for at least 24 hours secondary to
anoxic/ischemic and/or metabolic encephalopathy, thromboembolic event or
cerebral bleed. |
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2860 |
Comps-Pulm-Vent Prolonged |
Indicate whether the patient had
Pulmonary Insufficiency requiring ventilator.
Include (but not limited to) causes such as ARDS and pulmonary edema and/or
any patient requiring mechanical ventilation > 24 hours postoperatively. |
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From version 2.41 |
6/03 |
If
a patient is ventilated prior to cardiac surgery, would prolonged vent be a
complication? |
Only
if the hours ventilated post-op are > 24 hours. |
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2/05 |
Would the prolonged vent complication field be coded yes for a
patient who has been long-term ventilator dependent PRIOR to his CABG? Six months prior to the current
hospitalization, patient suffered multiple complications, including a
tracheostomy, from disease processes and non-cardiac surgery. |
Due to the language in the definition (...any patient requiring
mechanical ventilation > 24 hours postoperatively) and for consistent
coding, you will need to code the prolonged ventilation field for this patient
as "yes." Hopefully, the
acuity of this patient will be captured in the co-morbidities/risk factors. |
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2/05 |
The Prolonged Ventilation definition states patient
requiring mechanical ventilation > 24 hours postoperatively. Is the 24 hour language reflective of
continuous or total hours intubated?
Patient extubated in five hours, reintubated during that hospital stay
for an additional 20 hours. |
A total of 24 hours, including
initial and additional hours of mechanical ventilation, as stated in the Training
Manual. For your example you would
code yes to Prolonged Ventilation. |
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2870 |
Comps-Pulm-Pulm Embolism |
Indicate whether the patient had a
Pulmonary Embolism diagnosed by study such as V/Q scan, angiogram, or spiral
CT. |
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2880 |
Comps-Pulm-Pneumonia |
Indicate whether the patient had
Pneumonia diagnosed by any of the following: positive cultures of sputum,
transtracheal fluid, bronchial washings, and/or clinical findings consistent
with the diagnosis of pneumonia. May
include chest X-ray diagnostic of pulmonary infilitrates. |
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From version 2.41 |
5/03 |
The definition for pneumonia as a
post-op complication seems to indicate that pneumonia may only be entered as
a complication if cultures substantiate the diagnosis. Is this correct? |
After
much discussion with the Definitions Task Force, a positive culture is not
necessary to capture pneumonia as a complication. I very much stand corrected and apologize
to those Data Managers that received incorrect information. Cultures are not
necessary if there are clinical findings consistent with the diagnosis of
pneumonia. There seems to be so few
sputum cultures obtained these days, unless the patient is still
intubated. Please keep in mind that
atelectasis and effusions do not necessarily indicate pneumonia. Pneumonia is most often diagnosed by
CXR. Make sure that pneumonia is
present and documented so that you are not over-coding pneumonia. |
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2890 |
Comps-Renal-Renal Failure |
Indicate whether the patient had acute
or worsening renal failure resulting in one or more of the following: 1.
Increase of serun creatinine to > 2.0 and 2x most recent preoperative
creatinine level. 2. A
new requirement for dialysis postoperatively. |
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5/04 |
Can renal failure be captured both
as a risk factor and as a postoperative complication? In the Training Manual, the Data Field
Intent states "Was the pre-existing (before surgery) failure
worsened...." gives the impression that it could - based on the criteria
of a worsening creatinine or new need for dialysis post op. |
Yes, renal failure can be captured both as a risk factor and as a
complication, with the capture of the complication of renal failure based on
the criteria of a worsening creatinine or new requirement for dialysis
postoperatively. |
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2900 |
Comps-Renal-Dialysis Req |
Indicate whether the patient had a new requirement for dialysis
postoperatively. |
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5/04 |
Does the STS consider ultrafiltration, CVVH/CVVH-D or
CRRT as a form of dialysis? |
After contacting a number of Nephrologists,
ultrafiltration should not be coded as dialysis, but CVVH, CVVH-D and CRRT should
be coded as dialysis. |
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10/05 |
I read on the FAQ that CVVH should be coded as
dialysis. Should the new dialysis defintion require baseline creatinine
to at least double before we count CVVH as dialysis? We are using CVVH
more aggressively for fluid management in patients that probably would not
have undergone standard dialysis. We do not necessarily view it as a
complication, it can also be a management tool. |
Seq# 2900 CRenDial is the child field to Seq# 2890
CRenFail. So, to code Seq# 2900 CRenDial = Yes, the patient would have to
also have met the criteria and code Seq# 2890 CRenFail = Yes. If CVVH is
utilized as a tool for fluid management and the patient does not meet
criteria for renal failure, CVVH would not be coded as dialysis. |
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2910 |
Comps-Vasc-Illiac/Fem Dissect |
Indicate whether the patient had a dissection occurring in the iliac or
femoral arteries. |
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2920 |
Comps-Vasc-Acute Limb Isch |
Indicate whether the patient had any
complication producing limb ischemia.
This may include upper or lower limb ischemia. |
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2930 |
Comps-Other-Heart Block |
Indicate whether the patient had a new
heart block requiring the implantation of a permanent pacemaker of any type
prior to discharge. |
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8/04 |
Should Comps-Other-Heart Block be coded as "YES" if a
patient has a pacer placed for new SSS, 1st or 2nd degree heart blocks,
tachy/brady syndrome, or only for 3rd degree heart blocks? The definition states: New
heart block requiring the implantation of a permanent pacemaker prior to
discharge. The Training Manuel states:
Third degree heart block that required insertion of a permanent
pacemaker. |
Although the intent is not clear in the definition, the Training
Manual does make the intent clear: Third
degree heart block that required insertion of a permanent pacemaker. Restricted to third degree heart
blocks. Pacemaker may be of any
type." |
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2940 |
Comps-Other-Card Arrest |
Indicate whether the patient had a
cardiac arrest documented by one of the following: a.
ventricular fibrillation b.
rapid ventricular tachycardia with hemodynamic instability c.
asystole |
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8/04 |
If a patient has a DNR status and is expected to arrest and then
expire, do we count Cardiac Arrest as a complication? Or, do we only use this
field if they have an unexpected Cardiac Arrest? |
Per the Training Manual:
"...this field is to capture those events that are sudden or
acute in occurrence." Based on
that language, do not capture an arrest on a DNR patient. |
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12/04 |
I coded a patient as Cardiac Arrest = Yes because he had runs of NSVT
which required EP study, resulting in inducible ventricular fibrillation,
which then required AICD placement. Is this correct? |
Per the Training Manual:
"... (the intent of) this field is to capture those events that
are sudden or acute in occurrence."
Based on that language, do not capture ventricular fibrillation that
is induced in a controlled environment resulting in AICD placement. If the AICD was placed in the OR, this
placement can be captured as a ReOp for Other Cardiac Problem. |
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2950 |
Comps-Other-Anticoag Comps |
Indicate whether the patient had
bleeding, hemorrhage, and/or embolic events related to anticoagulant therapy
postoperatively. This may include
patients who experience Disseminated Intravascular Coagulopathy (DIC) or
Heparin Induced Thrombocytopenia (HIT). |
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From version 2.41 |
6/03 |
Please
clarify the timing on anticoagulant administration to capture an
anticoagulation complication? Are you
looking to capture the patient that has a PCI, receives Plavix, then goes for
a CABG, bleeds post op and has to return to the OR, or are you looking to
capture patients that receive anticoagulation therapy post-op, Heparin, for
their valve or CVA/embolic event and bleeds.
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The
intent of the field is to capture those patients that bleed, hemorrhage and
/or suffer an embolic event related to anticoagulant therapy received
post-op. |
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NEW! |
Comps-other-anticoag comps |
No, this is not an anticoagulation
complication. |
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2960 |
Comps-Other-Tamponade |
Indicate whether the patient had fluid
in the pericardial space compromising cardiac filling, and requiring
intervention other than returning to the OR such as pericardialcentesis.
This should be documented by either: 1. echo
showing pericardial fluid and signs of tamponade such as right heart
compromise, or 2. Systemic hypotension due to
pericardial fluid compromising cardiac function. |
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2970 |
Comps-Other-GI Comps |
Indicate whether the patient had a
postoperative occurrence of any GI complication including: a. GI
bleeding requiring transfusion b.
pancreatitis with abnormal amylase/lipase requiring nasogastric (NG) suction
therapy c.
cholecystitis requiring cholecystectomy or drainage d. mesenteric ischemia requiring
exploration e. other GI complications |
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11/04 |
Is placement of a PEG considered a GI complication? Patients that receive PEGs are generally
very sick patients that require long term nutritional support because of
multiple postoperative complications and the inability to eat. |
The Task Force feels that if a PEG is placed in the gut it means that
the gut is working well enough to support the nutritional support that the
PEG feedings are providing. Do not
code a GI complication in this situation.
The other GI complication option for this seq# is more to collect GI
bleeds, ileus/dead bowel, etc. |
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4/05 |
Is it
appropriate to capture patients that acquire Clostridium Difficile in the
postoperative period in the Comps-Other-GI Complications field? |
Yes. |
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2980 |
Comps-Other-Multi Sys Fail |
Indicate whether the patient had two or more major organ systems suffer
compromised functions. |
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9/04 |
1. If the patient has renal
failure that requires dialysis postoperatively that improves before
discharge. Is this organ failure? 2. If a patient is trached for
failure to wean postoperatively but ultimately gets extubated postop. ? Is
this an organ failure? |
3. If the patient is diagnosed
with liver failure as a result of hypoperfusion but improves upon discharge? Is this an organ failure? Multisystem organ failure means there is no revival of the organ and
its function. Mechanical and/or
pharmacological mechanisms do not revive the organ's function. Endstage means end stage, irreversible
organ failure. Therefore, a patient
that continues to be sustained by dialysis does not have endstage renal
disease, as they continue to live with mechanical assistance. A patient with prolonged ventilation time
resulting in the patients inability to be weaned resulting in ventilator
dependency is not endstage respiratory, as they continue to live with
mechanical assistance. |
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01/06 |
For patients that qualify for MSOF,
do we also include their complications in other areas so they are counted
twice for essentially the same thing?
For example, renal failure/prolonged vent/ pneumonia as well as MSOF? |
Yes. One patient can have multiple
complications. In the case of MSOF, the patient develops deterioration of one
system, i.e. pulmonary, then another and then another. |
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2990 |
Comps-Other-A Fib |
Indicate whether the patient had a new
onset of atrial fibrillation/flutter (AF) requiring treatment. Does not
include recurrence of AF which had been present preoperatively. |
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From version 2.41 |
8/03 |
Patient
is on beta blockers post-op and titrating each day to give higher doses. Second post-op day patient has two hour run
of A Fib. If during this run of A Fib
the beta blocker is increased or an extra dose of beta blocker is given but
no other drugs are given for this two hour period, would this be considered
an A Fib complication? |
The
intent of this field is to capture new onset A Fib that requires treatment
and not to capture a reoccurrence of A Fib which had been present
pre-op. If the patient did not have A
Fib pre-op and this post-op A Fib is new in onset requiring treatment = a
post-op A Fib complication. |
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3000 |
Comps-Ao Dissect |
Indicate whether the patient had a
dissection occurring in any part of the aorta. |
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3010 |
Comps-Other-Other |
Indicate whether a postoperative
complication occurred that is not identified in the categories above yet
impacts hospital length of stay and/or outcome. |
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