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CODINGREIMBURSE-MENT ANDCOST
CARE PATHDIAGRAM
PROCEDURECODING
PATIENTSCENARIOHISTORY
Point of Care Targeted by SeprafilmTM Point of Care Targeted by SeprafilmTM
1
© Premier Innovation Institute 2000. All rights reserved. These materials may not be reprinted or republished in any form without the express written consent of the Premier Innovation Institute.
[Insert Scenario Description]
PATIENT SCENARIO
Total Cost = $______
CODINGREIMBURSE-MENT ANDCOST
CARE PATHDIAGRAM
PROCEDURECODING
PATIENTSCENARIOHISTORY
Point of Care Targeted by SeprafilmTM Point of Care Targeted by SeprafilmTM
2
© Premier Innovation Institute 2000. All rights reserved. These materials may not be reprinted or republished in any form without the express written consent of the Premier Innovation Institute.
SurgicalTreatmentSurgical
Treatment
PATIENT WORKSHEET 1.0: COLON CANCER AND NEOPLASMSOverview of all diagnosis and procedures.
NOTE: THE FOLLOWING HOLDS TRUE FOR EVERY SCENARIO: REIMBURSEMENTS ARE NOT A REQUIRED FIELD. NOT ALL HOSPITALS PROVIDE ACCURATE REIMBURSEMENTS. THEY DO NOT EVEN PROVIDE ESTIMATED REIMBURSEMENTS. A MEDICARE REIMBURSEMENT SCHEDULE MAY BE MORE ACCURATE SINCE SOME OF THESE STATISTICS MAY BE UNDERREPORTED.
Recurrence ofPrimary DiseaseRecurrence of
Primary Disease
153.0 Hepatic Flexure153.1 Transverse Colon153.2 Descending Colon153.3 Sigmoid Colon153.4 Cecum153.6 Ascending Colon153.7 Splenic Flexure 153.8 Colon NEC153.9 Colon NOS154.0 Rectosigmoid JCT159.0 Intestine NOS
46.03 Loop Colostomy46.11 Temporary Colostomy46.01 Loop Ileostomy46.20 Ileostomy46.21 Temporary Ileostomy45.7 Partial Large Bowel Excision54.59 Lysis of Adhesions (Abdomen)
Pharm IV FluidPharm IV TPNLabs Blood WorkLabs All other excluding Blood workRad Plain Abd X-ray
Contrast Upper/LowerRad Chest X-rayPharm AntibioticsPharm All other MedsRad CT Scan (Abdomen)
45.75 Left Hemicolectomy45.73 Right Hemicolectomy45.8 Total Intra-Abd Colectomy45.74 Transverse Colon Resect45.76 Sigmoidectomy46.03 Loop Colostomy
(Exterz Large Intestine)46.10 Colostomy NOS46.11 Temporary Colostomy46.21 Temporary Ileostomy54.59 Lysis of Adhesions (Abdomen)
Subsequent Procedures
Subsequent Procedures
SurgicalTreatmentSurgical
Treatment
InitialComplication
InitialComplication
DischargeDischarge
DischargeDischarge
DischargeDischarge
DischargeDischarge
Complication*Complication*
Complication*Complication*
Small BowelObstruction
Small BowelObstruction
PlannedSubsequent Procedures
PlannedSubsequent Procedures
SurgicalTreatmentSurgical
Treatment
MedicalTreatmentMedical
Treatment
45.75 Left Hemicolectomy45.73 Right Hemicolectomy45.8 Total Intra-Abd Colectomy45.74 Transverse Colon Resect45.76 Sigmoidectomy46.10 Colostomy NOS48.69 Closure of HartmanXX.XX NG Suction54.59 Lysis of Adhesions (Abdomen46.03 Loop Colostomy46.11 Temporary Colostomy46.01 Loop Ileostomy46.20 Ileostomy46.21 Temporary Ileostomy)
AdjuvantTherapyAdjuvantTherapy
Recurrence ofPrimary DiseaseRecurrence of
Primary Disease
Other DiseaseProcesses
Other DiseaseProcesses
553.21 Incisional Hernia
OtherComplications
OtherComplications
AnastomoticProblems
AnastomoticProblems
997.4 Anastomotic Leak997.4 Anastomotic Stricture998.11 Post-op Hemorrhage
V55.2 Attention to IleostomyV55.3 Attention to Colostomy
PlannedSubsequent Procedures
PlannedSubsequent Procedures
54.59 Lysis of Adhesions (Abdomen)45.60 Other Small Bowel Excision46.01 Loop Ileostomy46.03 Loop Colostomy46.11 Temporary Colostomy46.20 Ileostomy46.21 Temporary Ileostomy46.51 Intestinal Stoma Closure45.90 Intestinal Anastimosis
CODINGREIMBURSE-MENT ANDCOST
CARE PATHDIAGRAM
PROCEDURECODING
PATIENTSCENARIOHISTORY
Point of Care Targeted by SeprafilmTM Point of Care Targeted by SeprafilmTM
3
© Premier Innovation Institute 2000. All rights reserved. These materials may not be reprinted or republished in any form without the express written consent of the Premier Innovation Institute.
PATIENT WORKSHEET 1.1: COLON CANCER AND NEOPLASMSA 70-year-old man presents with nausea, vomiting, and abdominal distention. He has guiac positive stool and has a dilated right colon on abdominal x-rays. A water-soluble contrast enema demonstrates an obstruction. The patient has an urgent abdominal colectomy, ileostomy and a Hartman’s closure of his rectum. He is discharged on POD #7. Two months later, he has an ileostomy taken down and an ileorectal anastomosis is performed. He recovered from both operations without complications. He is discharged on POD #4.
AnastomoticProblems
AnastomoticProblems
Subsequent Procedures
Subsequent Procedures
SurgicalTreatmentSurgical
Treatment
InitialComplication
InitialComplication
DischargeDischarge
OtherComplications
OtherComplications
DischargeDischarge
DischargeDischarge
DischargeDischarge
Complication*Complication*
Complication*Complication*
Small BowelObstruction
Small BowelObstruction
PlannedSubsequent Procedures
PlannedSubsequent Procedures
SurgicalTreatmentSurgical
Treatment
SurgicalTreatmentSurgical
Treatment
MedicalTreatmentMedical
Treatment
AdjuvantTherapyAdjuvantTherapy
Recurrence ofPrimary DiseaseRecurrence of
Primary Disease
Recurrence ofPrimary DiseaseRecurrence of
Primary Disease
Other DiseaseProcesses
Other DiseaseProcesses
PlannedSubsequent Procedures
PlannedSubsequent Procedures
153.4 Colon cancer
P 45.8 Total Intra-Abd Colectomy**NO PATIENTS FOUND WITH EITHER SECONDARY PROCEDURE USING THESE CODES.**S 4X.XX Hartman Resection of RectumS 46.21 Temporary Ileostomy
8 patientsALOS 10.75 $13,681 (Cost)
56 PatientsALOS 3.89
$4,693 (Cost)
P 46.51 Closure stoma small intestine
Total Cost = $18,374
DRG 148Major Small and Large Bowel Procedures with CCAverage National Payment $13,892.03
V55.2 Attention to Ileostomy
DRG 153Minor Small and Large Bowel Procedures without CCAverage National Payment $4,769.84
10-15% Incidence
CODINGREIMBURSE-MENT ANDCOST
CARE PATHDIAGRAM
PROCEDURECODING
PATIENTSCENARIOHISTORY
Point of Care Targeted by SeprafilmTM Point of Care Targeted by SeprafilmTM
4
© Premier Innovation Institute 2000. All rights reserved. These materials may not be reprinted or republished in any form without the express written consent of the Premier Innovation Institute.
PATIENT WORKSHEET 1.2: COLON CANCER AND NEOPLASMS
Total Cost = $21,157
A 70-year-old man presents with nausea, vomiting, and abdominal distention. He has guiac positive stool and has a dilated right colon on abdominal x-rays. A water-soluble contrast enema demonstrates an obstruction. The patient has an urgent abdominal colectomy, ileostomy and a Hartman’s closure of his rectum. He is discharged on POD #7. Two months later, he has an ileostomy taken down with lysis of adhesions and an ileorectal anastomosis is performed. He is discharged on POD #7.
AnastomoticProblems
AnastomoticProblems
Subsequent Procedures
Subsequent Procedures
SurgicalTreatmentSurgical
Treatment
InitialComplication
InitialComplication
DischargeDischarge
OtherComplications
OtherComplications
DischargeDischarge
DischargeDischarge
DischargeDischarge
Complication*Complication*
Complication*Complication*
Small BowelObstruction
Small BowelObstruction
PlannedSubsequent Procedures
PlannedSubsequent Procedures
SurgicalTreatmentSurgical
Treatment
SurgicalTreatmentSurgical
Treatment
MedicalTreatmentMedical
Treatment
AdjuvantTherapyAdjuvantTherapy
Recurrence ofPrimary DiseaseRecurrence of
Primary Disease
Recurrence ofPrimary DiseaseRecurrence of
Primary Disease
Other DiseaseProcesses
Other DiseaseProcesses
P 46.51 Closure Stoma small intestine S 54.59 Lysis of Adhesions
PlannedSubsequent Procedures
PlannedSubsequent Procedures
2 PatientsALOS 6.5
$ 7,476 (Cost)
P 45.8 Total Intra-Abd Colectomy**NO PATIENTS FOUND WITH EITHER SECONDARY PROCEDURE USING THESE CODES.**S 48.69 Closure of HartmanS 46.21 Temporary Ileostomy
153.4 Colon Cancer
DRG 148Major Small and Large Bowel Procedures with CCAverage National Payment $13,892.03
8 patientsALOS 10.75 $13,681 (Cost)
DRG 150Peritoneal Adhesiolysis without CCAverage National Payment $11,114.69
10-15% Incidence
V55.2 Attention to Ileostomy
CODINGREIMBURSE-MENT ANDCOST
CARE PATHDIAGRAM
PROCEDURECODING
PATIENTSCENARIOHISTORY
Point of Care Targeted by SeprafilmTM Point of Care Targeted by SeprafilmTM
5
© Premier Innovation Institute 2000. All rights reserved. These materials may not be reprinted or republished in any form without the express written consent of the Premier Innovation Institute.
PATIENT WORKSHEET 1.3: COLON CANCER AND NEOPLASMS
Total Cost = $23,899
A 70-year-old man presents with nausea, vomiting, and abdominal distention. He has guiac positive stool and has a dilated right and transverse colon on abdominal x-rays. A water-soluble contrast enema demonstrates an obstruction sigmoid cancer. The patient has an urgent sigmoid colectomy with a left colon colostomy and a Hartman’s closure of his rectum. Two months after this operation he has his colostomy taken down. On POD #4 he is given liquids and develops nausea and abdominal distention. Abdominal x-rays suggest a partial small bowel obstruction. This is treated with nasogastric suction and intravenous fluids. After 3 days the patient passes gas and his distention resolves. He resumes his diet and is discharged on POD #9.
Subsequent Procedures
Subsequent Procedures
DischargeDischarge
DischargeDischarge
DischargeDischarge
DischargeDischarge
Complication*Complication*
Complication*Complication*
PlannedSubsequent Procedures
PlannedSubsequent Procedures
SurgicalTreatmentSurgical
Treatment
SurgicalTreatmentSurgical
Treatment
AdjuvantTherapyAdjuvantTherapy
SurgicalTreatmentSurgical
Treatment
Recurrence ofPrimary DiseaseRecurrence of
Primary Disease
AnastomoticProblems
AnastomoticProblems
OtherComplications
OtherComplications
Recurrence ofPrimary DiseaseRecurrence of
Primary Disease
Other DiseaseProcesses
Other DiseaseProcesses
InitialComplication
InitialComplication
Small BowelObstruction
Small BowelObstruction
PlannedSubsequent Procedures
PlannedSubsequent Procedures
Pharm IV TPNPharm AntibioticsPharm Other MedsX-ray Plain Abd
(S800XR1000 )
$62.80 XRay
$396.79 IV TPN124 patientsALOS 5.65
$ 5,609 (Cost)
153.3 Sigmoid Colon
P 45.76 SigmoidectomyS 46.11 Temporary ColostomyS 4X.XX Hartman Resection of Rectum**DID NOT FIND ANY PATIENTS WITH SECOND SECONDARY PROCEDURE USING THAT CODE.**
13 patientsALOS 14.69
$15,722 (Cost) $738 Antibiotics
$1,756 Other Meds
(Tests/Meds already included in procedures)
DRG 148Major Small and Large Bowel Procedures with CCAverage National Payment $13,892.03
P 46.52 Closure stoma large intestine
V55.3 Attention to colostomy
DRG 153Minor Small and Large Bowel Procedures without CCAverage National Payment $4,769.94
10-15% Incidence
657 patientsALOS 3.68
$2,568 (Cost)
DRG 181GI Obstruction without CCAverage National Payment $2,133.64
P 96.07 Non operative Insert naso-gastric tube
560.9 SBO
MedicalTreatmentMedical
Treatment
CODINGREIMBURSE-MENT ANDCOST
CARE PATHDIAGRAM
PROCEDURECODING
PATIENTSCENARIOHISTORY
Point of Care Targeted by SeprafilmTM Point of Care Targeted by SeprafilmTM
6
© Premier Innovation Institute 2000. All rights reserved. These materials may not be reprinted or republished in any form without the express written consent of the Premier Innovation Institute.
PATIENT WORKSHEET 1.4: COLON CANCER AND NEOPLASMS
Total Cost = $31,964
A 70-year-old man presents with nausea, vomiting, and abdominal distention. He has guiac positive stool and has a dilated right and transverse colon on abdominal x-rays. A water-soluble contrast enema demonstrates an obstruction sigmoid cancer. The patient has an urgent sigmoid colectomy with a left colon colostomy and a Hartman’s closure of his rectum. Two months after this operation he has his colostomy taken down. On POD #4 he is given liquids and develops nausea and abdominal distention. Abdominal x-rays suggest small bowel obstruction. Small bowel obstruction diagnosed. Patient is surgically treated. Lysis of adhesions. He is discharged on POD #19.
Subsequent Procedures
Subsequent Procedures
DischargeDischarge
DischargeDischarge
DischargeDischarge
DischargeDischarge
Complication*Complication*
Complication*Complication*
PlannedSubsequent Procedures
PlannedSubsequent Procedures
SurgicalTreatmentSurgical
Treatment
SurgicalTreatmentSurgical
Treatment
AdjuvantTherapyAdjuvantTherapy
SurgicalTreatmentSurgical
Treatment
Recurrence ofPrimary DiseaseRecurrence of
Primary Disease
AnastomoticProblems
AnastomoticProblems
OtherComplications
OtherComplications
Recurrence ofPrimary DiseaseRecurrence of
Primary Disease
Other DiseaseProcesses
Other DiseaseProcesses
MedicalTreatmentMedical
TreatmentInitial
ComplicationInitial
Complication
Small BowelObstruction
Small BowelObstruction
PlannedSubsequent Procedures
PlannedSubsequent Procedures
124 patientsALOS 5.65
$ 5,609 (Cost)
153.3 Sigmoid Colon
P 45.76 SigmoidectomyS 46.11 Temporary ColostomyS 4X.XX Hartman Resection of Rectum**DID NOT FIND ANY PATIENTS WITH SECOND SECONDARY PROCEDURE USING THAT CODE.**
13 patientsALOS 14.69
$15,722 (Cost)
DRG 148Major Small and Large Bowel Procedures with CCAverage National Payment $13,892.03
P 46.52 Closure stoma large intestine
V55.3 Attention to colostomy
DRG 153Minor Small and Large Bowel Procedures without CCAverage National Payment $4,769.94
10-15% Incidence
15 PatientsALOS 12.93
$10,633 (Cost)
DRG 150Peritoneal Adhesiolysis with CCAverage National Payment $11,114.69
P 560.9 Small Bowel Obstruction
P 54.59 Lysis of Adhesions (Abdomen)
CODINGREIMBURSE-MENT ANDCOST
CARE PATHDIAGRAM
PROCEDURECODING
PATIENTSCENARIOHISTORY
Point of Care Targeted by SeprafilmTM Point of Care Targeted by SeprafilmTM
7
© Premier Innovation Institute 2000. All rights reserved. These materials may not be reprinted or republished in any form without the express written consent of the Premier Innovation Institute.
PATIENT WORKSHEET 1.5: COLON CANCER AND NEOPLASMS
Total Cost = $6,462
A 65-year-old women presents with fatigue and melana. A colonoscope reveals a 6 cm lesion of the cecum. She undergoes a right hemicolectomy with ileocolic anastomosis. She has an uneventful recovery and is discharged on POD #6.
50-75% Incidence
153.4 Cecum Cancer
P 45.73 Right Hemicolectomy
AnastomoticProblems
AnastomoticProblems
Subsequent Procedures
Subsequent Procedures
SurgicalTreatmentSurgical
Treatment
InitialComplication
InitialComplication
DischargeDischarge
OtherComplications
OtherComplications
DischargeDischarge
DischargeDischarge
DischargeDischarge
Complication*Complication*
Complication*Complication*
Small BowelObstruction
Small BowelObstruction
PlannedSubsequent Procedures
PlannedSubsequent Procedures
SurgicalTreatmentSurgical
Treatment
SurgicalTreatmentSurgical
Treatment
MedicalTreatmentMedical
Treatment
PlannedSubsequent Procedures
PlannedSubsequent Procedures
AdjuvantTherapyAdjuvantTherapy
Recurrence ofPrimary DiseaseRecurrence of
Primary Disease
Recurrence ofPrimary DiseaseRecurrence of
Primary Disease
Other DiseaseProcesses
Other DiseaseProcesses
46 PatientsALOS 6.11
$ 6,462 (Cost)
DRG 149Major Small and Large Bowel Procedures without CCAverage National Payment $6,352.95
CODINGREIMBURSE-MENT ANDCOST
CARE PATHDIAGRAM
PROCEDURECODING
PATIENTSCENARIOHISTORY
Point of Care Targeted by SeprafilmTM Point of Care Targeted by SeprafilmTM
8
© Premier Innovation Institute 2000. All rights reserved. These materials may not be reprinted or republished in any form without the express written consent of the Premier Innovation Institute.
AdjuvantTherapyAdjuvantTherapy
PATIENT WORKSHEET 1.6: COLON CANCER AND NEOPLASMS
Total Cost = $9,868
A 51-year-old woman is found with a large sessile polyp on screening flexible sigmoidoscopy. Colonoscopy reveals no other lesions, but the polyp is too big to remove with a colonoscope. She undergoes a sigmoid colectomy without complications. She is discharged on POD #6. Two years later, she develops RUQ abdominal pain and is found to have cholethiasis. She undergoes an uneventful cholecystectomy. She is discharged on POD #3.
InitialComplication
InitialComplication
DischargeDischarge
DischargeDischarge
DischargeDischarge
Complication*Complication*
Complication*Complication*
PlannedSubsequent Procedures
PlannedSubsequent Procedures
SurgicalTreatmentSurgical
Treatment
SurgicalTreatmentSurgical
Treatment
SurgicalTreatmentSurgical
Treatment
Recurrence ofPrimary DiseaseRecurrence of
Primary Disease
MedicalTreatmentMedical
Treatment
AnastomoticProblems
AnastomoticProblems
OtherComplications
OtherComplications
Small BowelObstruction
Small BowelObstruction
Recurrence ofPrimary DiseaseRecurrence of
Primary Disease
Other DiseaseProcesses
Other DiseaseProcesses
Subsequent Procedures
Subsequent Procedures
51.23 Laparascopic Cholecystectomy
PlannedSubsequent Procedures
PlannedSubsequent Procedures
DischargeDischarge
88 PatientsALOS 6.15
$6,108 (Cost)
1576 PatientsALOS 1.95
$3,760 (Cost)
153.3 Sigmoid 57410 Calculus of gallbladder with other cholecystitis, without mention of obstruction
DRG 494 Laparoscopic Cholecystectomy without Common Duct without CCAverage National Payment $3,854.00
DRG 149Major Small and Large Bowel Procedures without CCAverage National Payment $6,352.95
50-75% Incidence
P 45.76 Sigmoidectomy
CODINGREIMBURSE-MENT ANDCOST
CARE PATHDIAGRAM
PROCEDURECODING
PATIENTSCENARIOHISTORY
Point of Care Targeted by SeprafilmTM Point of Care Targeted by SeprafilmTM
9
© Premier Innovation Institute 2000. All rights reserved. These materials may not be reprinted or republished in any form without the express written consent of the Premier Innovation Institute.
AdjuvantTherapyAdjuvantTherapy
PATIENT WORKSHEET 1.7: COLON CANCER AND NEOPLASMS
Total Cost = $20,194
A 51-year-old woman is found with a large sessile polyp on screening flexible sigmoidoscopy. Colonoscopy reveals no other lesions, but the polyp is too big to remove with a colonoscope. She undergoes a sigmoid colectomy without complications. She is discharged on POD #6. Two years later, she develops RUQ abdominal pain. A CT scan reveals a solitary liver metastasis. She has a right lobectomy of her liver and is discharged two weeks later. Discharged POD #9.
50.3 Right Hepatic Lobectomy
DischargeDischarge
DischargeDischarge
DischargeDischarge
Complication*Complication*
Complication*Complication*
PlannedSubsequent Procedures
PlannedSubsequent Procedures
SurgicalTreatmentSurgical
Treatment
SurgicalTreatmentSurgical
Treatment
MedicalTreatmentMedical
Treatment
DischargeDischarge
OtherComplications
OtherComplications
Small BowelObstruction
Small BowelObstruction
Recurrence ofPrimary DiseaseRecurrence of
Primary Disease
Other DiseaseProcesses
Other DiseaseProcesses
PlannedSubsequent Procedures
PlannedSubsequent Procedures
InitialComplication
InitialComplication
Subsequent Procedures
Subsequent Procedures
Rad CT Scan (abdomen)S800CT1000 CT scan of abdomen w and w/o contrast
Recurrence ofPrimary DiseaseRecurrence of
Primary Disease
AnastomoticProblems
AnastomoticProblems
SurgicalTreatmentSurgical
Treatment
$187.9288 PatientsALOS 6.15
$6,108 (Cost)
197.7 Liver Metastasis
P 45.76 Sigmoidectomy
19 PatientsALOS 8.58
$14,086 (Cost)
153.3 Sigmoid
(Test already included in procedures)
DRG 149Major Small and Large Bowel Procedures without CCAverage National Payment $6,352.95
DRG 191 Pancreas, Liver and Shunt Procedures with CCAverage National Payment $17,830.90
50-75% Incidence
CODINGREIMBURSE-MENT ANDCOST
CARE PATHDIAGRAM
PROCEDURECODING
PATIENTSCENARIOHISTORY
Point of Care Targeted by SeprafilmTM Point of Care Targeted by SeprafilmTM
10
© Premier Innovation Institute 2000. All rights reserved. These materials may not be reprinted or republished in any form without the express written consent of the Premier Innovation Institute.
AdjuvantTherapyAdjuvantTherapy
46.51 Intestinal Stoma Closure45.90 Intestinal Anastomosis46.10 Colostomy NOS48.69 Closure of HartmanXX.XX NG Suction54.59 Lysis of Adhesions (Abdomen) 46.03 Loop Colostomy46.11 Temporary Colostomy46.01 Loop Ileostomy46.20 Ileostomy NOS46.21 Temporary Ileostomy
PATIENT WORKSHEET 2.0: RECTAL CANCER
153.0 Hepatic Flexure153.1 Transverse Colon153.2 Descending Colon153.3 Sigmoid Colon153.4 Cecum153.5 Appendix153.6 Ascending Colon153.7 Splenic Flexure153.8 Colon NEC153.9 Colon NOS154.0 Neoplasm Colon154.1 Rectum154.8 Rectum/Anus NEC159.0 Intestine NOS
48.41 Soave submucosal Rectal Pull Through
48.49 Other Rectal Pull Through48.5 Abd-Perineal Rectum Resection48.62 Anterior Rectum Resection
w/Colostomy48.69 Rectal Resection NEC48.63 Anterior Rectum Resection NEC46.03 Loop Colostomy (Exterz Large
Intestine)46.10 Colostomy NOS46.11 Temporary Colostomy46.21 Temp Ileostomy54.59 Lysis of Adhesions (Abdomen)XX.XX Small Bowel Suspension w/Sling
997.4 Anastomotic Leak998.11 Post-op Hemorrhage
54.59 Lysis of Adhesions (Abdomen)45.60 Small Bowel Resection46.01 Loop Ileostomy46.03 Loop Colostomy46.11 Temporary Colostomy46.01 Loop Ileostomy46.20 Ileostomy NOS46.21 Temp. Ileostomy46.51 Intestinal Stoma Closure45.90 Intestinal Anastomosis
46.03 Loop Colostomy46.11 Temporary Colostomy46.01 Loop Ileostomy46.20 Ileostomy NOS46.21 Temporary Ileostomy45.70 Partial resection of Large Intestine54.59 Lysis of Adhesions (Abdomen)
AnastomoticProblems
AnastomoticProblems
Subsequent Procedures
Subsequent Procedures
InitialComplication
InitialComplication
DischargeDischarge
DischargeDischarge
DischargeDischarge
DischargeDischarge
Complication*Complication*
Complication*Complication*
Small BowelObstruction
Small BowelObstruction
PlannedSubsequent Procedures
PlannedSubsequent Procedures
SurgicalTreatmentSurgical
Treatment
SurgicalTreatmentSurgical
Treatment
PlannedSubsequent Procedures
PlannedSubsequent Procedures
Recurrence ofPrimary DiseaseRecurrence of
Primary Disease
Recurrence ofPrimary DiseaseRecurrence of
Primary Disease
Other DiseaseProcesses
Other DiseaseProcesses
SurgicalTreatmentSurgical
Treatment
Overview of all diagnosis and procedures.
553.21 Incisional Hernia
OtherComplications
OtherComplications
V55.2 Attention to Ileostomy V55.3 Attention to Colostomy
MedicalTreatmentMedical
Treatment
Pharm IV FluidPharm IV TPNLabs BloodworkLabs All other excluding Blood workRad Plain Abd X-rayRad CT Scan (Abdomen)Pharm Coumadin (aka Warfarin), HeparinPharm AntibioticsPharm All other Meds
CODINGREIMBURSE-MENT ANDCOST
CARE PATHDIAGRAM
PROCEDURECODING
PATIENTSCENARIOHISTORY
Point of Care Targeted by SeprafilmTM Point of Care Targeted by SeprafilmTM
11
© Premier Innovation Institute 2000. All rights reserved. These materials may not be reprinted or republished in any form without the express written consent of the Premier Innovation Institute.
PATIENT WORKSHEET 2.1: RECTAL CANCERA 68-year-old man presents with rectal bleeding. A colonocsope reveals a 4 cm lesion of the rectum. He receives a low anterior resection. He has an uneventful recovery and is discharged on POD #7. Pathology revealed the tumor to be a T3N1 tumor. The patient received adjuvant chemoradiation.
154.1 Malignant Neoplasm Rectum
AnastomoticProblems
AnastomoticProblems
Subsequent Procedures
Subsequent Procedures
InitialComplication
InitialComplication
DischargeDischarge
OtherComplications
OtherComplications
DischargeDischarge
DischargeDischarge
DischargeDischarge
Complication*Complication*
Complication*Complication*
Small BowelObstruction
Small BowelObstruction
PlannedSubsequent Procedures
PlannedSubsequent Procedures
SurgicalTreatmentSurgical
Treatment
SurgicalTreatmentSurgical
Treatment
MedicalTreatmentMedical
Treatment
PlannedSubsequent Procedures
PlannedSubsequent Procedures
Recurrence ofPrimary DiseaseRecurrence of
Primary Disease
Recurrence ofPrimary DiseaseRecurrence of
Primary Disease
Other DiseaseProcesses
Other DiseaseProcesses
SurgicalTreatmentSurgical
Treatment
P 48.63 Anterior Rectum Resection NEC
25 PatientsALOS 6.8
$7,029 (Cost)
Total Cost = $7,530
V58.1 Chemotherapy
P 99.25 Chemoradiation
136 PatientsALOS 0 (outpatient)
$501 (Cost)
DRG 147Rectal Resection without CCAverage National Payment $6,512.85
No DRG - Outpatient procedure
50-75% Incidence
AdjuvantTherapyAdjuvantTherapy
CODINGREIMBURSE-MENT ANDCOST
CARE PATHDIAGRAM
PROCEDURECODING
PATIENTSCENARIOHISTORY
Point of Care Targeted by SeprafilmTM Point of Care Targeted by SeprafilmTM
12
© Premier Innovation Institute 2000. All rights reserved. These materials may not be reprinted or republished in any form without the express written consent of the Premier Innovation Institute.
AdjuvantTherapyAdjuvantTherapy
PATIENT WORKSHEET 2.2: RECTAL CANCERA 68-year-old man presents with rectal bleeding. A colonocsope reveals a 4 cm lesion of the rectum. He receives a low anterior resection. He has an uneventful recovery and is discharged on POD #7. Pathology revealed the tumor to be a T3N1 tumor. The patient received adjuvant chemoradiation.
154.1 Malignant Neoplasm Rectum
DischargeDischarge
DischargeDischarge
DischargeDischarge
DischargeDischarge
Complication*Complication*
Complication*Complication*
PlannedSubsequent Procedures
PlannedSubsequent Procedures
SurgicalTreatmentSurgical
Treatment
SurgicalTreatmentSurgical
Treatment
MedicalTreatmentMedical
Treatment
PlannedSubsequent Procedures
PlannedSubsequent Procedures
Recurrence ofPrimary DiseaseRecurrence of
Primary Disease
SurgicalTreatmentSurgical
Treatment
P 48.63 Anterior Rectum Resection NEC
25 PatientsALOS 6.8
$7,029 (Cost)
Total Cost = $15,006
V58.1 Chemotherapy
P 99.25 Chemoradiation
136 PatientsALOS 0 (outpatient)
$501 (Cost)
DRG 147Rectal Resection without CCAverage National Payment $6,512.85
No DRG - Outpatient procedure
50-75% Incidence
Subsequent Procedures
Subsequent Procedures
Recurrence ofPrimary DiseaseRecurrence of
Primary Disease
Other DiseaseProcesses
Other DiseaseProcesses
AnastomoticProblems
AnastomoticProblems
OtherComplications
OtherComplications
Small BowelObstruction
Small BowelObstruction
P 46.51 Closure Stoma small intestine S 54.59 Lysis of Adhesions
2 PatientsALOS5.6.50
$ 7,476 (Cost)
DRG 150Peritoneal Adhesiolysis without CCAverage National Payment $11,114.69
V55.2 Attention to Ileostomy
InitialComplication
InitialComplication
CODINGREIMBURSE-MENT ANDCOST
CARE PATHDIAGRAM
PROCEDURECODING
PATIENTSCENARIOHISTORY
Point of Care Targeted by SeprafilmTM Point of Care Targeted by SeprafilmTM
13
© Premier Innovation Institute 2000. All rights reserved. These materials may not be reprinted or republished in any form without the express written consent of the Premier Innovation Institute.
PATIENT WORKSHEET 2.3: RECTAL CANCERA 68-year-old man presents with rectal bleeding. A colonocsope reveals a 4 cm lesion of the rectum. He receives a low anterior resection. He has an uneventful recovery and is discharged on POD #7. Pathology revealed the tumor to be a T3N1 tumor. The patient received adjuvant chemoradiation.
154.1 Malignant Neoplasm Rectum
AnastomoticProblems
AnastomoticProblems
Subsequent Procedures
Subsequent Procedures
InitialComplication
InitialComplication
DischargeDischarge
OtherComplications
OtherComplications
DischargeDischarge
DischargeDischarge
DischargeDischarge
Complication*Complication*
Complication*Complication*
Small BowelObstruction
Small BowelObstruction
PlannedSubsequent Procedures
PlannedSubsequent Procedures
SurgicalTreatmentSurgical
Treatment
SurgicalTreatmentSurgical
Treatment
MedicalTreatmentMedical
Treatment
Recurrence ofPrimary DiseaseRecurrence of
Primary Disease
Recurrence ofPrimary DiseaseRecurrence of
Primary Disease
Other DiseaseProcesses
Other DiseaseProcesses
SurgicalTreatmentSurgical
Treatment
P 48.63 Anterior Rectum Resection NEC
25 PatientsALOS 6.8
$7,029 (Cost)
Total Cost = $10,098
V58.1 Chemotherapy
P 99.25 Chemoradiation
136 PatientsALOS 0 (outpatient)
$501 (Cost)
DRG 147Rectal Resection without CCAverage National Payment $6,512.85
No DRG - Outpatient procedure
50-75% Incidence
PlannedSubsequent Procedures
PlannedSubsequent Procedures
AdjuvantTherapyAdjuvantTherapy
Pharm IV TPNPharm AntibioticsPharm Other MedsX-ray Plain Abd
(S800XR1000 )
560.9 SBO
P 96.07 Non operative Insert naso-gastric tube
DRG 181GI Obstruction without CCAverage National Payment $2,133.64
657 PatinetsALOS 3.68
$2,568 (Cost)
$62.80 XRay
(Tests/Meds already included in procedures)
$396.79 IV TPN
$738 Antibiotics
$1,756 Other Meds
CODINGREIMBURSE-MENT ANDCOST
CARE PATHDIAGRAM
PROCEDURECODING
PATIENTSCENARIOHISTORY
Point of Care Targeted by SeprafilmTM Point of Care Targeted by SeprafilmTM
14
© Premier Innovation Institute 2000. All rights reserved. These materials may not be reprinted or republished in any form without the express written consent of the Premier Innovation Institute.
AdjuvantTherapyAdjuvantTherapy
PATIENT WORKSHEET 2.4: RECTAL CANCERA 68-year-old man presents with rectal bleeding. A colonocsope reveals a 4 cm lesion of the rectum. He receives a low anterior resection. He has an uneventful recovery and is discharged on POD #7. Pathology revealed the tumor to be a T3N1 tumor. The patient received adjuvant chemoradiation.
154.1 Malignant Neoplasm Rectum
AnastomoticProblems
AnastomoticProblems
Subsequent Procedures
Subsequent Procedures
InitialComplication
InitialComplication
DischargeDischarge
OtherComplications
OtherComplications
DischargeDischarge
DischargeDischarge
DischargeDischarge
Complication*Complication*
Complication*Complication*
Small BowelObstruction
Small BowelObstruction
PlannedSubsequent Procedures
PlannedSubsequent Procedures
SurgicalTreatmentSurgical
Treatment
SurgicalTreatmentSurgical
Treatment
MedicalTreatmentMedical
Treatment
Recurrence ofPrimary DiseaseRecurrence of
Primary Disease
Recurrence ofPrimary DiseaseRecurrence of
Primary Disease
Other DiseaseProcesses
Other DiseaseProcesses
SurgicalTreatmentSurgical
Treatment
P 48.63 Anterior Rectum Resection NEC
25 PatientsALOS 6.8
$7,029 (Cost)
Total Cost = $18,163
V58.1 Chemotherapy
P 99.25 Chemoradiation
136 PatientsALOS 0 (outpatient)
$501 (Cost)
DRG 147Rectal Resection without CCAverage National Payment $6,512.85
No DRG - Outpatient procedure
50-75% Incidence
PlannedSubsequent Procedures
PlannedSubsequent Procedures
15 PatientsALOS 12.93
$10,633 (Cost)
DRG 150Peritoneal Adhesiolysis with CCAverage National Payment $11,114.69
P 560.9 Small Bowel Obstruction
P 54.59 Lysis of Adhesions (Abdomen)
CODINGREIMBURSE-MENT ANDCOST
CARE PATHDIAGRAM
PROCEDURECODING
PATIENTSCENARIOHISTORY
Point of Care Targeted by SeprafilmTM Point of Care Targeted by SeprafilmTM
15
© Premier Innovation Institute 2000. All rights reserved. These materials may not be reprinted or republished in any form without the express written consent of the Premier Innovation Institute.
AdjuvantTherapyAdjuvantTherapy
PATIENT WORKSHEET 2.5: RECTAL CANCERA 70-year-old man presents with anal pain and bleeding. Evaluation reveals a lesion. He received an abdominal perineal resection. He is discharged on POD #10. The patient received adjuvant chemoradiation.
Subsequent Procedures
Subsequent Procedures
InitialComplication
InitialComplication
DischargeDischarge
OtherComplications
OtherComplications
DischargeDischarge
DischargeDischarge
DischargeDischarge
Complication*Complication*
Complication*Complication*
Small BowelObstruction
Small BowelObstruction
PlannedSubsequent Procedures
PlannedSubsequent Procedures
SurgicalTreatmentSurgical
Treatment
SurgicalTreatmentSurgical
Treatment
MedicalTreatmentMedical
Treatment
PlannedSubsequent Procedures
PlannedSubsequent Procedures
Recurrence ofPrimary DiseaseRecurrence of
Primary Disease
Recurrence ofPrimary DiseaseRecurrence of
Primary Disease
Other DiseaseProcesses
Other DiseaseProcesses
SurgicalTreatmentSurgical
Treatment
AnastomoticProblems
AnastomoticProblems
P 48.5 Abdominoperin Rectum Resection
117 PatientsALOS 10.53
$11,900 (Cost)
Total Cost = $12,401
P 154.1 Malignant Neoplasm Rectum
V58.1 Chemotherapy
P 99.25 Chemoradiation
No DRG - Outpatient procedure
136 PatientsALOS 0 (outpatient)
$501 (Cost)
DRG 146Rectal Resection with CCAverage National Payment $11,215.96
50-75% Incidence
CODINGREIMBURSE-MENT ANDCOST
CARE PATHDIAGRAM
PROCEDURECODING
PATIENTSCENARIOHISTORY
Point of Care Targeted by SeprafilmTM Point of Care Targeted by SeprafilmTM
16
© Premier Innovation Institute 2000. All rights reserved. These materials may not be reprinted or republished in any form without the express written consent of the Premier Innovation Institute.
PATIENT WORKSHEET 2.6: RECTAL CANCERA 63-year-old woman undergoes a low anterior resection for a rectal cancer. On POD #4, she develops a fever and abdominal pain. A water-soluble contrast enema demonstrates a leaking anastomosis. She receives an end colostomy and Hartman’s closure of her rectum. Three months later, she undergoes takedown of her colostomy with a colorectal anastomosis.
P 46.52 Closure stoma large intestine
Subsequent Procedures
Subsequent Procedures
DischargeDischarge
OtherComplications
OtherComplications
DischargeDischarge
DischargeDischarge
DischargeDischarge
Complication*Complication*
SurgicalTreatmentSurgical
Treatment
SurgicalTreatmentSurgical
Treatment
PlannedSubsequent Procedures
PlannedSubsequent Procedures
Recurrence ofPrimary DiseaseRecurrence of
Primary Disease
Recurrence ofPrimary DiseaseRecurrence of
Primary Disease
Other DiseaseProcesses
Other DiseaseProcesses
AdjuvantTherapyAdjuvantTherapy
SurgicalTreatmentSurgical
Treatment
AnastomoticProblems
AnastomoticProblems
MedicalTreatmentMedical
Treatment
P V55.3 Attention to Colostomy
Small BowelObstruction
Small BowelObstruction
Complication*Complication*
InitialComplication
InitialComplication
P 48.62 Anterior Rectum Resection w/ Colostomy
**NO PATIENTS FOUND WITH A SECONDARY DIAGNOSIS OF 48.69 - Rectum Resection
3 PatientsALOS 11.67
$12,297 (Cost)
Contrast Enema (Lower GI series) **NOT ABLE TO BREAK OUT COST SEPARATELY**
124 PatientsALOS 5.65
$5,609 (Cost)
PlannedSubsequent Procedures
PlannedSubsequent Procedures
Total Cost = $17,906
P 154.1 Malignant Neoplasm RectumS 997.4 Anastomotic Leak
DRG 146Rectal Resection with CCAverage National Payment $11,215.96
DRG 153Minor Small and Large Bowel Procedures without CCAverage National Payment $4,769.94
15-25% Incidence
CODINGREIMBURSE-MENT ANDCOST
CARE PATHDIAGRAM
PROCEDURECODING
PATIENTSCENARIOHISTORY
Point of Care Targeted by SeprafilmTM Point of Care Targeted by SeprafilmTM
17
© Premier Innovation Institute 2000. All rights reserved. These materials may not be reprinted or republished in any form without the express written consent of the Premier Innovation Institute.
45.75 Left Hemicolectomy45.73 Right Hemicolectomy45.8 Total Intra-Abd Colectomy45.74 Transverse Colon Resect45.76 Sigmoidectomy46.03 Loop Colostomy (Exterz Large Intestine)46.10 Colostomy NOS46.11 Temporary Colostomy48.62 Anterior Rectum Resection w/Colostomy48.63 Anterior Rectum Resection NEC54.59 Lysis of Adhesions (Abdomen)
562.10 Diverticulosis of Colon562.11 Diverticulitis of Colon562.12 Diverticulosis of Colon with Hemorrhage562.13 Diverticulitis of Colon with Hemorrhage
PATIENT WORKSHEET 3.0: DIVERTICULAR DISEASE
46.03 Loop Colostomy46.1 Colostomy46.11 Temporary Colostomy46.01 Loop Ileostomy46.20 Ileostomy NOS46.21 Temporary Ileostomy45.7 Partial Large Bowel Excision
AnastomoticProblems
AnastomoticProblems
Recurrence ofPrimary DiseaseRecurrence of
Primary Disease
Subsequent Procedures
Subsequent Procedures
SurgicalTreatmentSurgical
Treatment
DischargeDischarge
OtherComplications
OtherComplications
DischargeDischarge
DischargeDischarge
DischargeDischarge
Complication*Complication*
Complication*Complication*
Small BowelObstruction
Small BowelObstruction
PlannedSubsequent Procedures
PlannedSubsequent Procedures
SurgicalTreatmentSurgical
Treatment
Other DiseaseProcesses
Other DiseaseProcesses
V55.2 Attention to IleostomyV55.3 Attention to Colostomy
46.51 Intestinal Stoma Closure45.9 0 Intestinal Anastomosis46.03 Loop Colostomy46.11 Temporary Colostomy46.01 Loop Ileostomy46.20 Ileostomy NOS46.21 Temp. Ileostomy
SurgicalTreatmentSurgical
Treatment
54.59 Lysis of Adhesions (Abdomen)45.60 Small Bowel Resection46.51 Intestinal Stoma Closure45.90 Intestinal Anastomosis
Overview of all diagnosis and procedures.
MedicalTreatmentMedical
Treatment
PlannedSubsequent Procedures
PlannedSubsequent Procedures
InitialComplication
InitialComplication
Pharm IV FluidPharm IV TPN
Foley (CATH insertion)Labs Blood WorkLabs All other excluding Blood workRad Plain Abd X-ray
Contrast Upper/LowerRad CT Scan (Abdomen)Pharm Water Soluble Contrast
Upper/Lower EndoscopyPharm Antibiotics and Meds553.21 Incisional Hernia
997.4 Anastomotic Leak997.4 Anastomotic Stricture998.11 Post-op Hemorrhage
CODINGREIMBURSE-MENT ANDCOST
CARE PATHDIAGRAM
PROCEDURECODING
PATIENTSCENARIOHISTORY
Point of Care Targeted by SeprafilmTM Point of Care Targeted by SeprafilmTM
18
© Premier Innovation Institute 2000. All rights reserved. These materials may not be reprinted or republished in any form without the express written consent of the Premier Innovation Institute.
A 53-year-old moderately obese Missouri farmer presents with a 4-day history of left lower quadrant abdominal pain, fever of 39 oC, and a WBC of 16,000. A CT scan shows a 5 cm abscess in the left lower quadrant adjacent to the sigmoid colon, which has numerous diverticuli. The patient has 3 previous episodes of left lower quadrant pain and has been hospitalized once before to receive antibiotics. Colonoscopy showed no other lesion one year ago. The patient was taken immediately to the operating room where a sigmoid colectomy was performed and a Hartman’s rectal stump with end colostomy were constructed. Discharged POD #10. Six months later the patient returned to the operating room for colostomy closure. He is discharged POD #6.
PATIENT WORKSHEET 3.1: DIVERTICULAR DISEASE
P 46.52 Closure stoma of large intestine
Recurrence ofPrimary DiseaseRecurrence of
Primary Disease
Subsequent Procedures
Subsequent Procedures
InitialComplication
InitialComplication
DischargeDischarge
OtherComplications
OtherComplications
DischargeDischarge
DischargeDischarge
DischargeDischarge
Complication*Complication*
Complication*Complication*
Small BowelObstruction
Small BowelObstruction
Other DiseaseProcesses
Other DiseaseProcesses
SurgicalTreatmentSurgical
Treatment
SurgicalTreatmentSurgical
Treatment
MedicalTreatmentMedical
Treatment
AnastomoticProblems
AnastomoticProblems
PlannedSubsequent Procedures
PlannedSubsequent Procedures
PlannedSubsequent Procedures
PlannedSubsequent Procedures
$216.58 CT Scan
$454.19 Blood work
562.11 Diverticulitis of Colon
SurgicalTreatmentSurgical
Treatment
P 45.75 Left HemicolectomyS 46.11 Temporary Colostomy
9 PatientsALOS 10.11
$12,786 (Cost)
124 PatientsALOS 5.65
$5,609 (Cost)
(Tests already included in procedures)Total Cost = $18,395
Rad CT ScanS800CT1001 - CT Scanabdomen w/contrastLAB Blood Work
P V55.3 Attention to Colostomy
DRG 148Major Small and Large Bowel Procedures with CCAverage National Payment $13,892.03
DRG 153Minor Small and Large Bowel Procedures without CCAverage National Payment$ 4,769.94
10-15% Incidence
CODINGREIMBURSE-MENT ANDCOST
CARE PATHDIAGRAM
PROCEDURECODING
PATIENTSCENARIOHISTORY
Point of Care Targeted by SeprafilmTM Point of Care Targeted by SeprafilmTM
19
© Premier Innovation Institute 2000. All rights reserved. These materials may not be reprinted or republished in any form without the express written consent of the Premier Innovation Institute.
A 53-year-old moderately obese Missouri farmer presents with a 4-day history of left lower quadrant abdominal pain, fever of 39 oC, and a WBC of 16,000. A CT scan shows a 5 cm abscess in the left lower quadrant adjacent to the sigmoid colon, which has numerous diverticuli. The patient has 3 previous episodes of left lower quadrant pain and has been hospitalized once before to receive antibiotics. Colonoscopy showed no other lesion one year ago. The patient was taken immediately to the operating room where a sigmoid colectomy was performed and a Hartman’s rectal stump with end colostomy were constructed. Discharged POD #10. Six months later the patient returned to the operating room for colostomy closure. Adhesions are encountered and lysed. Patient is discharged on POD #9.
PATIENT WORKSHEET 3.2: DIVERTICULAR DISEASE
Recurrence ofPrimary DiseaseRecurrence of
Primary Disease
Subsequent Procedures
Subsequent Procedures
InitialComplication
InitialComplication
DischargeDischarge
OtherComplications
OtherComplications
DischargeDischarge
DischargeDischarge
DischargeDischarge
Complication*Complication*
Complication*Complication*
Small BowelObstruction
Small BowelObstruction
Other DiseaseProcesses
Other DiseaseProcesses
SurgicalTreatmentSurgical
Treatment
SurgicalTreatmentSurgical
Treatment
MedicalTreatmentMedical
Treatment
AnastomoticProblems
AnastomoticProblems
PlannedSubsequent Procedures
PlannedSubsequent Procedures
PlannedSubsequent Procedures
PlannedSubsequent Procedures
$216.58 CT Scan
$454.19 Blood work
562.11 Diverticulitis of Colon
SurgicalTreatmentSurgical
Treatment
P 45.75 Left HemicolectomyS 46.11 Temporary ColostomyS 4X.XX Hartman Resection of Rectum
9 PatientsALOS 10.11
$12,786 (Cost)
(Tests already included in procedures. Italicized costs are not included.)Total Cost = $22,464
Rad CT ScanS800CT1001 - CT Scanabdomen w/contrastLAB Blood Work
V55.3 Attention to Colostomy
DRG 148Major Small and Large Bowel Procedures with CCAverage National Payment $13,892.03
10-15% Incidence
P 46.52 Closure Stoma large intestine S 54.59 Lysis of Adhesions
69 PatientsALOS9.07
$ 9,678 (Cost)
DRG 150Peritoneal Adhesiolysis without CCAverage National Payment $11,114.69
CODINGREIMBURSE-MENT ANDCOST
CARE PATHDIAGRAM
PROCEDURECODING
PATIENTSCENARIOHISTORY
Point of Care Targeted by SeprafilmTM Point of Care Targeted by SeprafilmTM
20
© Premier Innovation Institute 2000. All rights reserved. These materials may not be reprinted or republished in any form without the express written consent of the Premier Innovation Institute.
A 72-year-old woman is admitted with massive lower GI hemorrhage. An angiogram revealed left-sided diverticuli with rapid bleeding. Vasopressin was used to stop the bleeding, and colonoscopy was performed after a rapid bowel prep. Diverticuli were noted throughout the sigmoid and left colon. The patient was taken immediately to the operating room where a sigmoid colectomy was performed and a Hartman’s rectal stump with end colostomy were constructed. Discharged POD #15. Six months later the patient returned to the operating room for colostomy closure through a major laparotomy incision. Seven days after left colectomy, the patient develops abdominal distension, nausea, and WBC of 14,000. Abdominal x-ray suggests partial SBO- this is treated with NG suction; and IV fluids. After 3 days distention resolves. Patient is discharged on POD #8.
PATIENT WORKSHEET 3.3: DIVERTICULAR DISEASE
Recurrence ofPrimary DiseaseRecurrence of
Primary Disease
Subsequent Procedures
Subsequent Procedures
SurgicalTreatmentSurgical
Treatment
DischargeDischarge
OtherComplications
OtherComplications
DischargeDischarge
DischargeDischarge
DischargeDischarge
Complication*Complication*
Complication*Complication*
Small BowelObstruction
Small BowelObstruction
PlannedSubsequent Procedures
PlannedSubsequent Procedures
Other DiseaseProcesses
Other DiseaseProcesses
SurgicalTreatmentSurgical
Treatment
SurgicalTreatmentSurgical
Treatment
MedicalTreatmentMedical
Treatment
AnastomoticProblems
AnastomoticProblems
PlannedSubsequent Procedures
PlannedSubsequent Procedures
Pharm IV FluidLAB Blood Work
InitialComplication
InitialComplication
P V55.3 Attention to Colostomy
P 46.52 Closure stoma large intestine
$151.61 IV fluid
$10.57 Blood work
P 45.76 SigmoidectomyS 46.11 Temporary Colostomy**NO PATIENTS FOUND WITH SECONDARY PROCEDURE OF RECTUM RESECTIONS 4X.XX Hartman Resection of Rectum
3 PatientsALOS 15.00
$34,840 (Cost)
136 PatientsALOS 6.91
$7,306 (Cost)
Total Cost = $44,714
562.12 Diverticulosis of Colon with Hemorrhage
DRG 148Major Small and Large Bowel Procedures with CCAverage National Payment $13,892.03
DRG 152Major Small and Large Bowel Procedures with CCAverage National Payment $7,846.99
10-15% Incidence
$62.80 XRay
$396.79 IV TPN
$738 Antibiotics
$1,756 Other Meds
657 PatientsALOS 3.68
$2,568 (Cost)
560.9 SBO
P 96.07 Non operative Insert naso-gastric tube
DRG 181GI Obstruction without CCAverage National Payment $2,133.64
Pharm IV TPNPharm AntibioticsPharm Other MedsX-ray Plain Abd
(S800XR1000 )
(Tests/Meds already included in procedures)
CODINGREIMBURSE-MENT ANDCOST
CARE PATHDIAGRAM
PROCEDURECODING
PATIENTSCENARIOHISTORY
Point of Care Targeted by SeprafilmTM Point of Care Targeted by SeprafilmTM
21
© Premier Innovation Institute 2000. All rights reserved. These materials may not be reprinted or republished in any form without the express written consent of the Premier Innovation Institute.
A 72-year-old woman is admitted with massive lower GI hemorrhage. An angiogram revealed left-sided diverticuli with rapid bleeding. Vasopressin was used to stop the bleeding, and colonoscopy was performed after a rapid bowel prep. Diverticuli were noted throughout the sigmoid and left colon. The patient was taken immediately to the operating room where a sigmoid colectomy was performed and a Hartman’s rectal stump with end colostomy were constructed. Discharged POD #15. Six months later the patient returned to the operating room for colostomy closure through a major laparotomy incision. Seven days after left colectomy, the patient develops abdominal distension, nausea, and WBC of 14,000. NG suction, IV fluid -- after two days and after initial symptoms show no progress, SBO diagnosed -- Lysis of Adhesion. Patient is discharged on POD #18.
PATIENT WORKSHEET 3.4: DIVERTICULAR DISEASE
P 54.59 Lysis of Adhesions (Abdomen)
Recurrence ofPrimary DiseaseRecurrence of
Primary Disease
Subsequent Procedures
Subsequent Procedures
SurgicalTreatmentSurgical
Treatment
DischargeDischarge
OtherComplications
OtherComplications
DischargeDischarge
DischargeDischarge
DischargeDischarge
Complication*Complication*
Complication*Complication*
Small BowelObstruction
Small BowelObstruction
PlannedSubsequent Procedures
PlannedSubsequent Procedures
Other DiseaseProcesses
Other DiseaseProcesses
SurgicalTreatmentSurgical
Treatment
SurgicalTreatmentSurgical
Treatment
MedicalTreatmentMedical
Treatment
AnastomoticProblems
AnastomoticProblems
PlannedSubsequent Procedures
PlannedSubsequent Procedures
Pharm IV FluidLAB Blood Work
InitialComplication
InitialComplication
P V55.3 Attention to Colostomy
P 46.52 Closure stoma large intestine
$151.61 IV fluid
$10.57 Blood work
P 45.76 SigmoidectomyS 46.11 Temporary Colostomy**NO PATIENTS FOUND WITH SECONDARY PROCEDURE OF RECTUM RESECTIONS 4X.XX Hartman Resection of Rectum
3 PatientsALOS 15.00
$34,840 (Cost)
136 PatientsALOS 6.91
$7,306 (Cost)
15 PatientsALOS 12.93
$10,633 (Cost)
(Tests already included in procedures)Total Cost = $52,779
562.12 Diverticulosis of Colon with Hemorrhage
DRG 148Major Small and Large Bowel Procedures with CCAverage National Payment $13,892.03
DRG 152Major Small and Large Bowel Procedures with CCAverage National Payment $7,846.99
DRG 150Peritoneal Adhesiolysis with CCAverage National Payment $11,114.69
P 560.9 Small Bowel Obstruction
10-15% Incidence
CODINGREIMBURSE-MENT ANDCOST
CARE PATHDIAGRAM
PROCEDURECODING
PATIENTSCENARIOHISTORY
Point of Care Targeted by SeprafilmTM Point of Care Targeted by SeprafilmTM
22
© Premier Innovation Institute 2000. All rights reserved. These materials may not be reprinted or republished in any form without the express written consent of the Premier Innovation Institute.
562.11 Diverticulitis of Colon
PATIENT WORKSHEET 3.5: DIVERTICULAR DISEASE
AnastomoticProblems
AnastomoticProblems
Recurrence ofPrimary DiseaseRecurrence of
Primary Disease
Subsequent Procedures
Subsequent Procedures
SurgicalTreatmentSurgical
Treatment
InitialComplication
InitialComplication
DischargeDischarge
OtherComplications
OtherComplications
DischargeDischarge
DischargeDischarge
DischargeDischarge
Complication*Complication*
Complication*Complication*
Small BowelObstruction
Small BowelObstruction
PlannedSubsequent Procedures
PlannedSubsequent Procedures
Other DiseaseProcesses
Other DiseaseProcesses
SurgicalTreatmentSurgical
Treatment
SurgicalTreatmentSurgical
Treatment
PlannedSubsequent Procedures
PlannedSubsequent Procedures
A 53-year-old moderately obese Missouri farmer presents with a 4-day history of left lower quadrant abdominal pain, fever of 39 oC, and a WBC of 16,000. A CT scan shows a 5 cm abscess in the left lower quadrant adjacent to the sigmoid colon, which has numerous diverticuli. When the pain and palpable mass resolved, the patient underwent a left colectomy with primary anastomosis. Patient is discharged on POD#9.
MedicalTreatmentMedical
Treatment
P 45.75 Left Hemicolectomy
130 PatientsALOS 10.76
$11,747 (Cost)
Total Cost = $11,747
DRG 148Major Small and Large Bowel Procedures with CCAverage National Payment $13,892.03
50-75% Incidence
CODINGREIMBURSE-MENT ANDCOST
CARE PATHDIAGRAM
PROCEDURECODING
PATIENTSCENARIOHISTORY
Point of Care Targeted by SeprafilmTM Point of Care Targeted by SeprafilmTM
23
© Premier Innovation Institute 2000. All rights reserved. These materials may not be reprinted or republished in any form without the express written consent of the Premier Innovation Institute.
A 53-year-old moderately obese Missouri farmer presents with a 4-day history of left lower quadrant abdominal pain, fever of 39 oC, and a WBC of 16,000. A CT scan shows a 5 cm abscess in the left lower quadrant adjacent to the sigmoid colon, which has numerous diverticuli. The patient has 3 previous episodes of left lower quadrant pain and has been hospitalized once before to receive antibiotics. Colonoscopy showed no other lesion one year ago. The patient was taken immediately to the operating room where a sigmoid colectomy was performed and a Hartman’s rectal stump with end colostomy were constructed. Six months later the patient returned to the operating room for colostomy closure through a major laparotomy incision. Seven days after left colectomy, the patient develops abdominal distension, nausea, fever of 39oC, and WBC of 14,000. A CT scan revealed an abscess in the pelvis with a leak of contrast from the colorectal anastomosis. The patient is returned to the operating room for abdominal washout, repair/revision of the anastomosis, placement of pelvic drains and diverting loop ileostomy. The loop ileostomy is closed eight weeks later after a hypaque enema reveals no leak.
PATIENT WORKSHEET 3.6: DIVERTICULAR DISEASE
P 46.52 Closure stoma of large intestine
Recurrence ofPrimary DiseaseRecurrence of
Primary Disease
Subsequent Procedures
Subsequent Procedures
InitialComplication
InitialComplication
DischargeDischarge
OtherComplications
OtherComplications
DischargeDischarge
DischargeDischarge
DischargeDischarge
Complication*Complication*
Complication*Complication*
Small BowelObstruction
Small BowelObstruction
Other DiseaseProcesses
Other DiseaseProcesses
SurgicalTreatmentSurgical
Treatment
SurgicalTreatmentSurgical
Treatment
MedicalTreatmentMedical
Treatment
AnastomoticProblems
AnastomoticProblems
PlannedSubsequent Procedures
PlannedSubsequent Procedures
PlannedSubsequent Procedures
PlannedSubsequent Procedures
$216.58 CT Scan
$454.19 Blood work
562.11 Diverticulitis of Colon
SurgicalTreatmentSurgical
Treatment
P 45.75 Left HemicolectomyS 46.11 Temporary ColostomyS 4X.XX Hartman Resection of Rectum
9 PatientsALOS 10.11
$12,786 (Cost)
124 PatientsALOS 5.65
$5,609 (Cost)
46.51 Closure Stoma Small Intestine
56 PatientsALOS 3.89
$4,693 (Cost)
(Tests already included in procedures)Total Cost = $45,902
Rad CT ScanS800CT1001 - CT Scanabdomen w/contrastLAB Blood Work
P V55.3 Attention to Colostomy
DRG 148Major Small and Large Bowel Procedures with CCAverage National Payment $13,892.03
DRG 153Minor Small and Large Bowel Procedures without CCAverage National Payment$ 4,769.94
46.20 Ileostomy NOS
P 997.4 Anastomotic LeakS 569.5 Abscess of intestine **NO PATIENTS FOUND WITH ABSCESS AS SECONDARY DIAGNOSIS.
DRG 148Major Small and Large Bowel Procedures with CCAverage National Payment $13,892.03
3 PatientsALOS 17.00
$21,117 (Cost)
P V55.2 Attention to Ileostomy
DRG 153Minor Small and Large Bowel Procedures without CCAverage National Payment $4,769.94
10-15% Incidence
CODINGREIMBURSE-MENT ANDCOST
CARE PATHDIAGRAM
PROCEDURECODING
PATIENTSCENARIOHISTORY
Point of Care Targeted by SeprafilmTM Point of Care Targeted by SeprafilmTM
24
© Premier Innovation Institute 2000. All rights reserved. These materials may not be reprinted or republished in any form without the express written consent of the Premier Innovation Institute.
A 53-year-old moderately obese Missouri farmer presents with a 4-day history of left lower quadrant abdominal pain, fever of 39 oC, and a WBC of 16,000. A CT scan shows a 5 cm abscess in the left lower quadrant adjacent to the sigmoid colon, which has numerous diverticuli. The patient has 3 previous episodes of left lower quadrant pain and has been hospitalized once before to receive antibiotics. Colonoscopy showed no other lesion one year ago. The patient was taken immediately to the operating room where a sigmoid colectomy was performed and a Hartman’s rectal stump with end colostomy were constructed. Six months later the patient returned to the operating room for colostomy closure through a major laparotomy incision. Dense adhesions were encountered and an enterotomy occurred during their division. This was repaired and the colostomy was closed. Four days after this procedure, the patient develops abdominal distension, nausea, fever of 39oC, and WBC of 14,000. A CT scan revealed an abscess in the pelvis with a leak of contrast from the small bowel. The patient is returned to the operating room for abdominal washout, and a diverting ileostomy using the site of the leak. The ileostomy is closed eight weeks later.
PATIENT WORKSHEET 3.7: DIVERTICULAR DISEASE
P 46.52 Closure stoma of large intestine
Recurrence ofPrimary DiseaseRecurrence of
Primary Disease
Subsequent Procedures
Subsequent Procedures
InitialComplication
InitialComplication
DischargeDischarge
OtherComplications
OtherComplications
DischargeDischarge
DischargeDischarge
DischargeDischarge
Complication*Complication*
Complication*Complication*
Small BowelObstruction
Small BowelObstruction
Other DiseaseProcesses
Other DiseaseProcesses
SurgicalTreatmentSurgical
Treatment
SurgicalTreatmentSurgical
Treatment
MedicalTreatmentMedical
Treatment
AnastomoticProblems
AnastomoticProblems
PlannedSubsequent Procedures
PlannedSubsequent Procedures
PlannedSubsequent Procedures
PlannedSubsequent Procedures
$216.58 CT Scan
$454.19 Blood workToo High?
562.11 Diverticulitis of Colon
SurgicalTreatmentSurgical
Treatment
P 45.75 Left HemicolectomyS 46.11 Temporary ColostomyS 4X.XX Hartman Resection of Rectum
9 PatientsALOS 10.11
$12,786 (Cost)
124 PatientsALOS 5.65
$5,609 (Cost)
46.51 Closure Stoma Small Intestine
56 PatientsALOS 3.89
$4,693 (Cost)
(Tests already included in procedures)Total Cost = $45,902
Rad CT ScanS800CT1001 - CT Scanabdomen w/contrastLAB Blood Work
P V55.3 Attention to Colostomy
DRG 148Major Small and Large Bowel Procedures with CCAverage National Payment $13,892.03
DRG 153Minor Small and Large Bowel Procedures without CCAverage National Payment$ 4,769.94
46.20 Ileostomy NOS
P 997.4 Anastomotic LeakS 569.5 Abscess of intestine **NO PATIENTS FOUND WITH ABSCESS AS SECONDARY DIAGNOSIS.
DRG 148Major Small and Large Bowel Procedures with CCAverage National Payment $13,892.03
3 PatientsALOS 17.00
$21,117 (Cost)
P V55.2 Attention to Ileostomy
DRG 153Minor Small and Large Bowel Procedures without CCAverage National Payment $4,769.94
10-15% Incidence
CODINGREIMBURSE-MENT ANDCOST
CARE PATHDIAGRAM
PROCEDURECODING
PATIENTSCENARIOHISTORY
Point of Care Targeted by SeprafilmTM Point of Care Targeted by SeprafilmTM
25
© Premier Innovation Institute 2000. All rights reserved. These materials may not be reprinted or republished in any form without the express written consent of the Premier Innovation Institute.
AnastomoticProblems
AnastomoticProblems
OtherComplications
OtherComplications
Small BowelObstruction
Small BowelObstruction
863.20 Small Intestine Injury-Closed863.21 Duodenum Injury-Closed863.29 Small Intestine Injury NEC-Closed863.39 Small Intestine Injury Open863.40 Colon Injury NOS-Closed863.41 Ascending Colon Injury-Closed863.42 Transverse Colon Injury-Closed863.43 Descending Colon Injury-Closed863.44 Sigmoid Colon Injury-Closed 863.45 Rectum Injury-Closed863.46 Colon Injury Mult Site-Closed863.49 Colon Injury NEC-Closed863.89 GI Injury NEC-Closed
PATIENT WORKSHEET 4.0: INTESTINAL TRAUMA
553.21 Incisional Hernia
46.51 Intestinal Stoma Closure45.90 Intestinal Anastomosys46.03 Loop Colostomy46.11 Temporary Colostomy46.01 Loop Ileostomy46.20 Ileostomy NOS46.21 Temporary Ileostomy
V55.2 Attention to IleostomyV55.3 Attention to Colostomy
997.4 Anastomotic Leak997.4 Anastomotic Stricture998.11 Post-op Hemorrhage
46.03 Loop Colostomy46.11 Temporary Colostomy46.01 Loop Ileostomy46.20 Ileostomy NOS46.21 Temporary Ileostomy46.93 Revision of Small Bowel Anastomosis46.94 Rev of Large Bowel Anastomosis45.7 Partial Large Bowel Excision
Subsequent Procedures
Subsequent Procedures
SurgicalTreatmentSurgical
Treatment
InitialComplication
InitialComplication
DischargeDischarge
DischargeDischarge
DischargeDischarge
DischargeDischarge
Complication*Complication*
Complication*Complication*
Other DiseaseProcesses
Other DiseaseProcesses
SurgicalTreatmentSurgical
Treatment
PlannedSubsequent Procedures
PlannedSubsequent Procedures
MedicalTreatmentMedical
Treatment
54.59 Lysis of Adhesions (Abdomen)45.60 Small Bowel Resection46.51 Intestinal Stoma Closure45.90 Intestinal Anastomosis
PlannedSubsequent Procedures
PlannedSubsequent Procedures
SurgicalTreatmentSurgical
Treatment
Overview of all diagnosis and procedures.
Pharm IV FluidPharm IV TPN
Foley (CATH insertion)Labs Blood WorkLabs All other excluding Blood workRad Plain Abd X-ray
Contrast Upper/LowerRad CT Scan (Abdomen)Pharm Water Soluble Contrast
Upper/Lower EndoscopyPharm Antibiotics and Meds
45.61 Multiple Seg Small Bowel Excision45.71 Multiple Seg Large Bowel Excision45.72 Cectomy45.73 Right Hemicolectomy45.74 Transverse Colectomy45.75 Left Hemicolectomy45.76 Sigmoidectomy46.03 Loop Colostomy45.8 Total Intra Abd Colectomy46.10 Colostomy NOS46.11 Temporary Colostomy48.62 Anterior Rectum Resection w/Colostomy48.63 Anterior Rectum Resection NEC48.69 Other resection Rectum48.5 Abd-Perineal Rectum Resection48.79 Repair of Rectum NEC45.61 Multiple segmental resection of small
intestine45.62 Other partial resection of small intestine46.75 Suture Large Bowel Laceration46.73 Small Bowel Suture NEC
CODINGREIMBURSE-MENT ANDCOST
CARE PATHDIAGRAM
PROCEDURECODING
PATIENTSCENARIOHISTORY
Point of Care Targeted by SeprafilmTM Point of Care Targeted by SeprafilmTM
26
© Premier Innovation Institute 2000. All rights reserved. These materials may not be reprinted or republished in any form without the express written consent of the Premier Innovation Institute.
PATIENT WORKSHEET 4.1: INTESTINAL TRAUMAA 22-year-old man sustains a gunshot wound to the abdomen. At abdominal exploration, he has a hole in his colon and two small bowel injuries. He receives a small bowel resection, an end sigmoid colostomy, and Hartman’s closure of his rectum. He is discharged on POD #7. Two months later his colostomy is closed. He is discharged on POD #6.
** DID NOT FIND ANY PATIENTS WITH EITHER OF THESE DIAGNOSIS *863.44 Sigmoid Colon Injury-Closed 863.89 GI Injury NEC-ClosedUSED 863.30 - Injury unspecified site with open wound cavity
P 46.52 Closure stoma large intestine
AnastomoticProblems
AnastomoticProblems
Small BowelObstruction
Small BowelObstruction
Subsequent Procedures
Subsequent Procedures
SurgicalTreatmentSurgical
Treatment
InitialComplication
InitialComplication
DischargeDischarge
DischargeDischarge
DischargeDischarge
DischargeDischarge
Complication*Complication*
Complication*Complication*
Other DiseaseProcesses
Other DiseaseProcesses
PlannedSubsequent Procedures
PlannedSubsequent Procedures
MedicalTreatmentMedical
Treatment
PlannedSubsequent Procedures
PlannedSubsequent Procedures
SurgicalTreatmentSurgical
Treatment
SurgicalTreatmentSurgical
Treatment
P V55.3 Attention to colostomy
OtherComplications
OtherComplications
*DID NOT FIND THIS PROCEDURE AS EITHERPRINCIPAL OR SECONDARY* 48.62 Anterior Rectum Resection w/ ColostomyP 45.62 Other Small Bowel ExcisionS 46.79 Other repair of intestine
4 PatientsALOS 11.75
$10,232 (Cost)
124 PatientsALOS 5.65
$5,609 (Cost)
Total Cost = $15,841
DRG 148Major Small and Large Bowel Procedures with CCAverage National Payment $13,892.03
DRG 153Minor Small and Large Bowel Procedures without CCAverage National Payment $4,769.94
15-25% Incidence
CODINGREIMBURSE-MENT ANDCOST
CARE PATHDIAGRAM
PROCEDURECODING
PATIENTSCENARIOHISTORY
Point of Care Targeted by SeprafilmTM Point of Care Targeted by SeprafilmTM
27
© Premier Innovation Institute 2000. All rights reserved. These materials may not be reprinted or republished in any form without the express written consent of the Premier Innovation Institute.
PATIENT WORKSHEET 4.2: INTESTINAL TRAUMAA 22-year-old man sustains a gunshot wound to the abdomen. At abdominal exploration, he has a hole in his colon and two small bowel injuries. He receives a small bowel resection, an end sigmoid colostomy, and Hartman’s closure of his rectum. He is discharged on POD #7. Two months later his colostomy is closed. Adhesions are encountered and lysed. He is discharged on POD #9.
** DID NOT FIND ANY PATIENTS WITH EITHER OF THESE DIAGNOSIS *863.44 Sigmoid Colon Injury-Closed 863.89 GI Injury NEC-ClosedUSED 863.30 - Injury unspecified site with open wound cavity
AnastomoticProblems
AnastomoticProblems
Small BowelObstruction
Small BowelObstruction
Subsequent Procedures
Subsequent Procedures
SurgicalTreatmentSurgical
Treatment
InitialComplication
InitialComplication
DischargeDischarge
DischargeDischarge
DischargeDischarge
DischargeDischarge
Complication*Complication*
Complication*Complication*
Other DiseaseProcesses
Other DiseaseProcesses
PlannedSubsequent Procedures
PlannedSubsequent Procedures
MedicalTreatmentMedical
Treatment
PlannedSubsequent Procedures
PlannedSubsequent Procedures
SurgicalTreatmentSurgical
Treatment
SurgicalTreatmentSurgical
TreatmentOther
ComplicationsOther
Complications
*DID NOT FIND THIS PROCEDURE AS EITHERPRINCIPAL OR SECONDARY* 48.62 Anterior Rectum Resection w/ ColostomyP 45.62 Other Small Bowel ExcisionS 46.79 Other repair of intestine
4 PatientsALOS 11.75
$10,232 (Cost)
Total Cost = $19,910
DRG 148Major Small and Large Bowel Procedures with CCAverage National Payment $13,892.03
15-25% Incidence
P 46.52 Closure Stoma large intestine S 54.59 Lysis of Adhesions
69 PatientsALOS 9.07
$ 9,678 (Cost)
DRG 150Peritoneal Adhesiolysis without CCAverage National Payment $11,114.69
V55.3 Attention to Colostomy
CODINGREIMBURSE-MENT ANDCOST
CARE PATHDIAGRAM
PROCEDURECODING
PATIENTSCENARIOHISTORY
Point of Care Targeted by SeprafilmTM Point of Care Targeted by SeprafilmTM
28
© Premier Innovation Institute 2000. All rights reserved. These materials may not be reprinted or republished in any form without the express written consent of the Premier Innovation Institute.
PATIENT WORKSHEET 4.3: INTESTINAL TRAUMAA 22-year-old man sustains a gunshot wound to the abdomen. At abdominal exploration, he has a hole in his colon and two small bowel injuries. He receives a small bowel resection, an end sigmoid colostomy, and Hartman’s closure of his rectum. He is discharged on POD #7. Two months later his colostomy is closed. On POD #4, he develops nausea and distension. X-ray suggests a partial small bowel obstruction. This is treated with NG suction and IV fluids. After 3 days, the patient passes gas and his distention is resolved. He is discharged on POD #9.
** DID NOT FIND ANY PATIENTS WITH EITHER OF THESE DIAGNOSIS *863.44 Sigmoid Colon Injury-Closed 863.89 GI Injury NEC-ClosedUSED 863.30 - Injury unspecified site with open wound cavity
P 46.52 Closure stoma large intestine
AnastomoticProblems
AnastomoticProblems
Small BowelObstruction
Small BowelObstruction
Subsequent Procedures
Subsequent Procedures
SurgicalTreatmentSurgical
Treatment
InitialComplication
InitialComplication
DischargeDischarge
DischargeDischarge
DischargeDischarge
DischargeDischarge
Complication*Complication*
Complication*Complication*
Other DiseaseProcesses
Other DiseaseProcesses
PlannedSubsequent Procedures
PlannedSubsequent Procedures
MedicalTreatmentMedical
Treatment
PlannedSubsequent Procedures
PlannedSubsequent Procedures
SurgicalTreatmentSurgical
Treatment
SurgicalTreatmentSurgical
Treatment
P V55.3 Attention to colostomy
OtherComplications
OtherComplications
*DID NOT FIND THIS PROCEDURE AS EITHERPRINCIPAL OR SECONDARY* 48.62 Anterior Rectum Resection w/ ColostomyP 45.62 Other Small Bowel ExcisionS 46.79 Other repair of intestine
4 PatientsALOS 11.75$10,232 (Cost)
124 PatientsALOS 5.65
$5,609 (Cost)
Total Cost = $18,409
DRG 148Major Small and Large Bowel Procedures with CCAverage National Payment $13,892.03
DRG 153Minor Small and Large Bowel Procedures without CCAverage National Payment $4,769.94
15-25% Incidence
560.9 SBO
DRG 181GI Obstruction without CCAverage National Payment $2,133.64
657 PatientsALOS 3.68
$2,568 (Cost)
P 96.07 Non operative Insert naso-gastric tube
$62.80 XRay
$396.79 IV TPN
$738 Antibiotics
$1,756 Other Meds
Pharm IV TPNPharm AntibioticsPharm Other MedsX-ray Plain Abd
(S800XR1000 )
(Tests/Meds already included in procedures)
CODINGREIMBURSE-MENT ANDCOST
CARE PATHDIAGRAM
PROCEDURECODING
PATIENTSCENARIOHISTORY
Point of Care Targeted by SeprafilmTM Point of Care Targeted by SeprafilmTM
29
© Premier Innovation Institute 2000. All rights reserved. These materials may not be reprinted or republished in any form without the express written consent of the Premier Innovation Institute.
PATIENT WORKSHEET 4.4: INTESTINAL TRAUMAA 22-year-old man sustains a gunshot wound to the abdomen. At abdominal exploration, he has a hole in his colon and two small bowel injuries. He receives a small bowel resection, an end sigmoid colostomy, and Hartman’s closure of his rectum. He is discharged on POD #7. Two months later his colostomy is closed. Four days after procedure, patient develops abdominal distention and nausea. Abdominal x-ray reveals small bowel obstruction. Patient is operated for small bowel obstruction and lysis of adhesion. Patient is discharged on POD #18.
** DID NOT FIND ANY PATIENTS WITH EITHER OF THESE DIAGNOSIS *863.44 Sigmoid Colon Injury-Closed 863.89 GI Injury NEC-ClosedUSED 863.30 - Injury unspecified site with open wound cavity
P 46.52 Closure stoma large intestine
AnastomoticProblems
AnastomoticProblems
Small BowelObstruction
Small BowelObstruction
Subsequent Procedures
Subsequent Procedures
SurgicalTreatmentSurgical
Treatment
InitialComplication
InitialComplication
DischargeDischarge
DischargeDischarge
DischargeDischarge
DischargeDischarge
Complication*Complication*
Complication*Complication*
Other DiseaseProcesses
Other DiseaseProcesses
PlannedSubsequent Procedures
PlannedSubsequent Procedures
MedicalTreatmentMedical
Treatment
PlannedSubsequent Procedures
PlannedSubsequent Procedures
SurgicalTreatmentSurgical
Treatment
SurgicalTreatmentSurgical
Treatment
P V55.3 Attention to colostomy
OtherComplications
OtherComplications
*DID NOT FIND THIS PROCEDURE AS EITHERPRINCIPAL OR SECONDARY* 48.62 Anterior Rectum Resection w/ ColostomyP 45.62 Other Small Bowel ExcisionS 46.79 Other repair of intestine
4 PatientsALOS 11.75
$10,232 (Cost)
124 PatientsALOS 5.65
$5,609 (Cost)
Total Cost = $26,474
DRG 148Major Small and Large Bowel Procedures with CCAverage National Payment $13,892.03
DRG 153Minor Small and Large Bowel Procedures without CCAverage National Payment $4,769.94
15-25% Incidence
15 PatientsALOS 12.93
$10,633 (Cost)
DRG 150Peritoneal Adhesiolysis with CCAverage National Payment $11,114.69
P 560.9 Small Bowel Obstruction
P 54.59 Lysis of Adhesions (Abdomen)
CODINGREIMBURSE-MENT ANDCOST
CARE PATHDIAGRAM
PROCEDURECODING
PATIENTSCENARIOHISTORY
Point of Care Targeted by SeprafilmTM Point of Care Targeted by SeprafilmTM
30
© Premier Innovation Institute 2000. All rights reserved. These materials may not be reprinted or republished in any form without the express written consent of the Premier Innovation Institute.
PATIENT WORKSHEET 5.0: ULCERATIVE COLITIS and FAMILIAL POLYPOSIS DISEASE
45.79 Resection of Colon45.8 Total Colectomy48.49 Rectal Pull Through48.5 Abd-Perineal Rectum Resection45.95 Endo Rectal Ileal Pouch46.01 Loop Ileostomy46.20 Ileostomy46.21 Temporary Ileostomy46.22 Continent Ileostomy54.59 Lysis of Adhesions (Abdomen)
556.3 Ulcerative556.4 Left Sided UC556.6 Universal UC556.8 Other UC211.2 Familial PolyposisXXXX HNPCC
46.01 Loop Ileostomy46.20 Ileostomy NOS46.21 Temp. Ileostomy45.95 Endo Rectal Ileal Pouch54.59 Lysis of Adhesions (Abdomen)
AnastomoticProblems
AnastomoticProblems
Small BowelObstruction
Small BowelObstruction
Subsequent Procedures
Subsequent Procedures
SurgicalTreatmentSurgical
Treatment
InitialComplication
InitialComplication
DischargeDischarge
DischargeDischarge
DischargeDischarge
DischargeDischarge
Complication*Complication*
Complication*Complication*
Other DiseaseProcesses
Other DiseaseProcesses
SurgicalTreatmentSurgical
TreatmentPlanned
Subsequent Procedures
PlannedSubsequent Procedures
46.51 Intestinal Stoma Closure45.90 Intestinal Anastomosis45.79 Resection of Colon45.8 Total Colectomy48.49 Rectal Pull Through48.5 Abd-Perineal Rectum Resection45.95 Endo Rectal Ileal Pouch46.01 Loop Ileostomy46.20 Ileostomy NOS46.21 Temporary Ileostomy46.22 Continent Ileostomy54.59 Lysis of Adhesions (Abdomen)
V55.2 Attention to IleostomyV55.3 Attention to Colostomy
PlannedSubsequent Procedures
PlannedSubsequent Procedures
997.4 Anastomotic Leak997.4 Anastomotic Stricture998.11 Post-op Hemorrhage
SurgicalTreatmentSurgical
Treatment
54.59 Lysis of Adhesions (Abdomen)45.60 Small Bowel Resection46.51 Intestinal Stoma Closure45.90 Intestinal Anastomosis54.59 Lysis of Adhesions (Abdomen)
Overview of all diagnosis and procedures.
MedicalTreatmentMedical
Treatment
553.21 Incisional Hernia
OtherComplications
OtherComplications
Pharm IV FluidPharm IV TPN
Foley (CATH insertion)Labs Blood WorkLabs All other excluding Blood workRad Plain Abd X-ray
Contrast Upper/LowerRad CT Scan (Abdomen)Pharm Water Soluble Contrast
Upper/Lower EndoscopyPharm Antibiotics and Meds
CODINGREIMBURSE-MENT ANDCOST
CARE PATHDIAGRAM
PROCEDURECODING
PATIENTSCENARIOHISTORY
Point of Care Targeted by SeprafilmTM Point of Care Targeted by SeprafilmTM
31
© Premier Innovation Institute 2000. All rights reserved. These materials may not be reprinted or republished in any form without the express written consent of the Premier Innovation Institute.
PATIENT WORKSHEET 5.1: ULCERATIVE COLITIS and FAMILIAL POLYPOSIS DISEASEAn 18-year-old female student develops severe abdominal pain, distension, bloody diarrhea, and elevated WBC. A short flexible sigmoidoscopy reveals acute severe fulminant colitis—either ulcerative colitis or Crohn’s Disease. The patient fails to respond to medication over the next 48 hours and begins to deteriorate with fever, peritoneal signs, and sepsis. She receives restorative proctocolectomy and an ileal J pouch, ileoanal anastomosis, and loop ileostomy. Discharge POD #9. Her ileostomy is closed two months after her initial operation when a hypaque enema shows no leak. Discharge POD #4.
AnastomoticProblems
AnastomoticProblems
OtherComplications
OtherComplications
Small BowelObstruction
Small BowelObstruction
Subsequent Procedures
Subsequent Procedures
InitialComplication
InitialComplication
DischargeDischarge
DischargeDischarge
DischargeDischarge
DischargeDischarge
Complication*Complication*
Complication*Complication*
Other DiseaseProcesses
Other DiseaseProcesses
SurgicalTreatmentSurgical
Treatment
MedicalTreatmentMedical
Treatment
PlannedSubsequent Procedures
PlannedSubsequent Procedures
SurgicalTreatmentSurgical
Treatment
PlannedSubsequent Procedures
PlannedSubsequent Procedures
556.6 Universal UC
P 45.8 Total ColectomyS 45.95 Endo Rectal Ileal PouchS 46.01 Loop Ileostomy
SurgicalTreatmentSurgical
Treatment
P 46.51 Closure Intestinal StomaS 87.64 Hypaque Enema (Lower GI Series)
5 PatientsALOS 16.20
$20,758 (Cost)
56 PatientsALOS 3.89
$4,693 (Cost)
Total Cost = $25,451
DRG 148Major Small and Large Bowel Procedures with CCAverage National Payment $13,892.03
P V55.2 Attention to ileostomy
DRG 153Minjor Small and Large Bowel Procedures without CCAverage National Payment $4,769.94
90% Incidence
CODINGREIMBURSE-MENT ANDCOST
CARE PATHDIAGRAM
PROCEDURECODING
PATIENTSCENARIOHISTORY
Point of Care Targeted by SeprafilmTM Point of Care Targeted by SeprafilmTM
32
© Premier Innovation Institute 2000. All rights reserved. These materials may not be reprinted or republished in any form without the express written consent of the Premier Innovation Institute.
PATIENT WORKSHEET 5.2: ULCERATIVE COLITIS and FAMILIAL POLYPOSIS DISEASEAn 18-year-old female student develops severe abdominal pain, distension, bloody diarrhea, and elevated WBC. A short flexible sigmoidoscopy reveals acute severe fulminant colitis—either ulcerative colitis or Crohn’s Disease. The patient fails to respond to medication over the next 48 hours and begins to deteriorate with fever, peritoneal signs, and sepsis. She receives restorative proctocolectomy and an ileal J pouch, ileoanal anastomosis, and loop ileostomy. Discharge POD #16. Her ileostomy is closed two months after her initial operation. Adhesions are encountered and lysed. Discharge POD #7.
AnastomoticProblems
AnastomoticProblems
OtherComplications
OtherComplications
Small BowelObstruction
Small BowelObstruction
Subsequent Procedures
Subsequent Procedures
InitialComplication
InitialComplication
DischargeDischarge
DischargeDischarge
DischargeDischarge
DischargeDischarge
Complication*Complication*
Complication*Complication*
Other DiseaseProcesses
Other DiseaseProcesses
SurgicalTreatmentSurgical
Treatment
MedicalTreatmentMedical
Treatment
PlannedSubsequent Procedures
PlannedSubsequent Procedures
SurgicalTreatmentSurgical
Treatment
PlannedSubsequent Procedures
PlannedSubsequent Procedures
556.6 Universal UC
P 45.8 Total ColectomyS 45.95 Endo Rectal Ileal PouchS 46.01 Loop Ileostomy
SurgicalTreatmentSurgical
Treatment
5 PatientsALOS 16.20
$20,758 (Cost)
Total Cost = $28,234
DRG 148Major Small and Large Bowel Procedures with CCAverage National Payment $13,892.03
90% Incidence
P 46.51 Closure Stoma small intestine S 54.59 Lysis of Adhesions
2 PatientsALOS5.6.50
$ 7,476 (Cost)
DRG 150Peritoneal Adhesiolysis without CCAverage National Payment $11,114.69
V55.2 Attention to Ileostomy
CODINGREIMBURSE-MENT ANDCOST
CARE PATHDIAGRAM
PROCEDURECODING
PATIENTSCENARIOHISTORY
Point of Care Targeted by SeprafilmTM Point of Care Targeted by SeprafilmTM
33
© Premier Innovation Institute 2000. All rights reserved. These materials may not be reprinted or republished in any form without the express written consent of the Premier Innovation Institute.
PATIENT WORKSHEET 5.3: ULCERATIVE COLITIS and FAMILIAL POLYPOSIS DISEASEAn 18-year-old female student develops severe abdominal pain, distension, bloody diarrhea, and elevated WBC. A short flexible sigmoidoscopy reveals acute severe fulminant colitis—either ulcerative colitis or Crohn’s Disease. The patient fails to respond to medication over the next 48 hours and begins to deteriorate with fever, peritoneal signs, and sepsis. She receives restorative proctocolectomy and an ileal J pouch, ileoanal anastomosis, and loop ileostomy. Discharge POD #16. Her ileostomy is closed two months after her initial operation. Three days after procedure, patient develops abdominal distention and nausea. X-ray reveals partial small bowel obstruction, which is treated with NG suction and IV fluid. Three days after diagnosis, patient passes gas and distention resolves. Discharge POD #8.
AnastomoticProblems
AnastomoticProblems
OtherComplications
OtherComplications
Small BowelObstruction
Small BowelObstruction
Subsequent Procedures
Subsequent Procedures
InitialComplication
InitialComplication
DischargeDischarge
DischargeDischarge
DischargeDischarge
DischargeDischarge
Complication*Complication*
Complication*Complication*
Other DiseaseProcesses
Other DiseaseProcesses
SurgicalTreatmentSurgical
Treatment
MedicalTreatmentMedical
Treatment
PlannedSubsequent Procedures
PlannedSubsequent Procedures
SurgicalTreatmentSurgical
Treatment
PlannedSubsequent Procedures
PlannedSubsequent Procedures
556.6 Universal UC
P 45.8 Total ColectomyS 45.95 Endo Rectal Ileal PouchS 46.01 Loop Ileostomy
SurgicalTreatmentSurgical
Treatment
P 46.51 Closure Intestinal StomaS 87.64 Hypaque Enema (Lower GI Series)
5 PatientsALOS 16.20
$28,758 (Cost)
56 PatientsALOS 3.89
$4,693 (Cost)
Total Cost = $36,019
DRG 148Major Small and Large Bowel Procedures with CCAverage National Payment $13,892.03
P V55.2 Attention to ileostomy
DRG 153Minjor Small and Large Bowel Procedures without CCAverage National Payment $4,769.94
90% Incidence
560.9 SBO
DRG 181GI Obstruction without CCAverage National Payment $2,133.64
657 PatientsALOS 3.68
$2,568 (Cost)
P 96.07 Non operative Insert naso-gastric tube
$62.80 XRay
$396.79 IV TPN
$1,756 Other Meds
Pharm IV TPNPharm AntibioticsPharm Other MedsX-ray Plain Abd
(S800XR1000 )
(Tests/Meds already included in procedures)
$738 Antibiotics
CODINGREIMBURSE-MENT ANDCOST
CARE PATHDIAGRAM
PROCEDURECODING
PATIENTSCENARIOHISTORY
Point of Care Targeted by SeprafilmTM Point of Care Targeted by SeprafilmTM
34
© Premier Innovation Institute 2000. All rights reserved. These materials may not be reprinted or republished in any form without the express written consent of the Premier Innovation Institute.
PATIENT WORKSHEET 5.4: ULCERATIVE COLITIS and FAMILIAL POLYPOSIS DISEASEAn 18-year-old female student develops severe abdominal pain, distension, bloody diarrhea, and elevated WBC. A short flexible sigmoidoscopy reveals acute severe fulminant colitis—either ulcerative colitis or Crohn’s Disease. The patient fails to respond to medication over the next 48 hours and begins to deteriorate with fever, peritoneal signs, and sepsis. She receives restorative proctocolectomy and an ileal J pouch, ileoanal anastomosis, and loop ileostomy. Discharge POD #16. Her ileostomy is closed two months after her initial operation. Seven days after procedure, patient experiences abdominal distention, nausea, and WBC 14,000. X-ray reveals small bowel obstruction and lysis of adhesion. Discharge POD #17.
AnastomoticProblems
AnastomoticProblems
OtherComplications
OtherComplications
Small BowelObstruction
Small BowelObstruction
Subsequent Procedures
Subsequent Procedures
InitialComplication
InitialComplication
DischargeDischarge
DischargeDischarge
DischargeDischarge
DischargeDischarge
Complication*Complication*
Complication*Complication*
Other DiseaseProcesses
Other DiseaseProcesses
SurgicalTreatmentSurgical
Treatment
MedicalTreatmentMedical
Treatment
PlannedSubsequent Procedures
PlannedSubsequent Procedures
SurgicalTreatmentSurgical
Treatment
PlannedSubsequent Procedures
PlannedSubsequent Procedures
556.6 Universal UC
P 45.8 Total ColectomyS 45.95 Endo Rectal Ileal PouchS 46.01 Loop Ileostomy
SurgicalTreatmentSurgical
Treatment
P 46.51 Closure Intestinal StomaS 87.64 Hypaque Enema (Lower GI Series)
5 PatientsALOS 16.20
$20,758 (Cost)
56 PatientsALOS 3.89
$4,693 (Cost)
Total Cost = $36,084
DRG 148Major Small and Large Bowel Procedures with CCAverage National Payment $13,892.03
P V55.2 Attention to ileostomy
DRG 153Minjor Small and Large Bowel Procedures without CCAverage National Payment $4,769.94
90% Incidence
P 54.59 Lysis of Adhesions (Abdomen)
15 PatientsALOS 12.93
$10,633 (Cost)
DRG 150Peritoneal Adhesiolysis with CCAverage National Payment $11,114.69
P 560.9 Small Bowel Obstruction
CODINGREIMBURSE-MENT ANDCOST
CARE PATHDIAGRAM
PROCEDURECODING
PATIENTSCENARIOHISTORY
Point of Care Targeted by SeprafilmTM Point of Care Targeted by SeprafilmTM
35
© Premier Innovation Institute 2000. All rights reserved. These materials may not be reprinted or republished in any form without the express written consent of the Premier Innovation Institute.
PATIENT WORKSHEET 5.5: ULCERATIVE COLITIS and FAMILIAL POLYPOSIS DISEASEAn 18-year-old female student develops severe abdominal pain, distension, bloody diarrhea, and elevated WBC. A short flexible sigmoidoscopy reveals acute severe fulminant colitis—either ulcerative colitis or Crohn’s Disease. The patient fails to respond to medication over the next 48 hours and begins to deteriorate with fever, peritoneal signs, and sepsis. Total abdominal colectomy with ileostomy and Hartman’s stump of rectum are performed emergently. The patient improves. Discharge POD #4. Three months later undergoes completion proctectomy with ileal J pouch and ileoanal anastomosis with loop ileostomy. Discharge POD #7. The ileostomy is closed three months later. Discharge POD #4. One year after ileostomy closure, the patient complains of incomplete evacuation of the pouch requiring 20 trips to the toilet daily. Examination reveals a narrowed 3 cm long segment of the pouch just proximal to the staple line of the anastomosis. Daily self intubations of the pouch with a catheter to empty the pouch. Discharge POD #4.
AnastomoticProblems
AnastomoticProblems
Small BowelObstruction
Small BowelObstruction
Subsequent Procedures
Subsequent Procedures
InitialComplication
InitialComplication
DischargeDischarge
DischargeDischarge
DischargeDischarge
DischargeDischarge
Complication*Complication*
Complication*Complication*
Other DiseaseProcesses
Other DiseaseProcesses
SurgicalTreatmentSurgical
TreatmentPlanned
Subsequent Procedures
PlannedSubsequent Procedures
SurgicalTreatmentSurgical
Treatment
MedicalTreatmentMedical
Treatment
OtherComplications
OtherComplications
Second PlannedSubsequent Procedure
Second PlannedSubsequent Procedure
SurgicalTreatmentSurgical
Treatment
PlannedSubsequent Procedures
PlannedSubsequent Procedures
P 45.8 Total ColectomyS 46.01 Ileostomy P 48.5 Abdominoperin resection
rectum
6 PatientsALOS 27.83
$31,645 (Cost)
29 PatientsALOS 6.76
$8,219 (Cost)
46.51 Closure stoma small intestine
56 PatientsALOS 3.89
$4,693 (Cost)
Total Cost = $44,557
556.6 Universal UC
DRG 148Major Small and Large Bowel Procedures with CCAverage National Payment $13,892.03
P V55.2 Attention to ileostomy
DRG 147Rectal resection without CCAverage National Payment $6,512.85
DRG 153Minor small and large bowel procedures without CCAverage National Payment $4,769.94
90% Incidence
CODINGREIMBURSE-MENT ANDCOST
CARE PATHDIAGRAM
PROCEDURECODING
PATIENTSCENARIOHISTORY
Point of Care Targeted by SeprafilmTM Point of Care Targeted by SeprafilmTM
36
© Premier Innovation Institute 2000. All rights reserved. These materials may not be reprinted or republished in any form without the express written consent of the Premier Innovation Institute.
PATIENT WORKSHEET 6.0: CROHN’S DISEASE (REGIONAL ENTERITIS)
45.79 Resection of Colon45.75 Left Colectomy45.73 Right Hemicolectomy45.76 Sigmoid Colectomy45.62 Partial Small Bowel resection45.8 Total Colectomy48.5 Abd-Perineal Rectum Resection46.01 Loop Ileostomy46.20 Ileostomy NOS46.21 Temporary Ileostomy46.79 Other Repair of Intestine46.10 Colostomy46.03 Loop Colostomy54.59 Lysis of Adhesions (Abdomen)
997.4 Anastomotic Leak997.4 Anastomotic Stricture998.11 Post-op Hemorrhage
AnastomoticProblems
AnastomoticProblems
Small BowelObstruction
Small BowelObstruction
Subsequent Procedures
Subsequent Procedures
SurgicalTreatmentSurgical
Treatment
InitialComplication
InitialComplication
DischargeDischarge
DischargeDischarge
DischargeDischarge
DischargeDischarge
Complication*Complication*
Complication*Complication*
Other DiseaseProcesses
Other DiseaseProcesses
SurgicalTreatmentSurgical
Treatment
46.50 Intestinal Stoma Closure45.90 Intestinal Anastomosis45.79 Resection of Colon45.8 Total Colectomy48.5 Abd-Perineal Rectum Resection46.01 Loop Ileostomy46.20 Ileostomy NOS46.21 Temporary Ileostomy54.59 Lysis of Adhesions (Abdomen)
SurgicalTreatmentSurgical
Treatment
MedicalTreatmentMedical
Treatment
Recurrence ofPrimary DiseaseRecurrence of
Primary Disease
Overview of all diagnosis and procedures.
OtherComplications
OtherComplications
PlannedSubsequent Procedures
PlannedSubsequent Procedures
V55.2 Attention to IleostomyV55.3 Attention to Colostomy
PlannedSubsequent Procedures
PlannedSubsequent Procedures
45.79 Resection of Colon45.75 Left Colectomy45.73 Right Hemicolectomy45.76 Sigmoid Colectomy45.62 Partial Small BowelResection45.8 Total Colectomy48.5 Abd-Perineal Rectum Resection46.01 Loop Ileostomy46.20 Ileostomy NOS46.21 Temp. Ileostomy54.59 Lysis of Adhesions (Abdomen)46.51 Intestinal Stoma Closure45.60 Small Bowel Resection45.90 Intestinal Anastomosis
555.0 Small Intestine555.1 Large Intestine555.2 Ileocolitis555.9 Unspecified Site
553.21 Incisional Hernia
Pharm IV FluidPharm IV TPN
Foley (CATH insertion)Labs Blood WorkLabs All other excluding Blood workRad Plain Abd X-ray
Contrast Upper/LowerRad CT Scan (Abdomen)Pharm Water Soluble Contrast
Upper/Lower Endoscopy
Pharm Antibiotics and Meds
CODINGREIMBURSE-MENT ANDCOST
CARE PATHDIAGRAM
PROCEDURECODING
PATIENTSCENARIOHISTORY
Point of Care Targeted by SeprafilmTM Point of Care Targeted by SeprafilmTM
37
© Premier Innovation Institute 2000. All rights reserved. These materials may not be reprinted or republished in any form without the express written consent of the Premier Innovation Institute.
AnastomoticProblems
AnastomoticProblems
OtherComplications
OtherComplications
Small BowelObstruction
Small BowelObstruction
A 24-year-old sales representative of a biotech company develops acute right lower quadrant pain. An upper GI/small bowel follow through subsequently shows 20 cm of inflammatory bowel disease in the terminal ileum to the ileosecal valve. The patient’s symptoms improve only slightly with medication until another acute episode occurs. A CT scan shows phegman in the right lower quadrant adjacent to the cecum. Exploration, ileocolic resection, drains, ileotransverse colon anastomosis and loop ileostomy. Patient discharged POD #9. Ileostomy is closed three months later. Patient is discharged POD#4
PATIENT WORKSHEET 6.1: CROHN’S DISEASE (REGIONAL ENTERITIS)
555.2 Regional Enteritis of Small Intestine with Large Intestine
Subsequent Procedures
Subsequent Procedures
SurgicalTreatmentSurgical
Treatment
InitialComplication
InitialComplication
DischargeDischarge
DischargeDischarge
DischargeDischarge
DischargeDischarge
Complication*Complication*
Complication*Complication*
Other DiseaseProcesses
Other DiseaseProcesses
PlannedSubsequent Procedures
PlannedSubsequent Procedures
SurgicalTreatmentSurgical
Treatment
SurgicalTreatmentSurgical
Treatment
MedicalTreatmentMedical
Treatment
Recurrence ofPrimary DiseaseRecurrence of
Primary Disease
PlannedSubsequent Procedures
PlannedSubsequent Procedures
27 PatientsALOS 8.76
$9,403 (Cost)
P 45.73 Right HemicolectomyS 46.01 Loop Ileostomy
56 PatientsALOS 3.89
$4,693 (Cost)
46.51 Closure Stoma small intestine
Total Cost = $14,096
DRG 148Major Small and Large Bowel Procedures with CCAverage National Payment $13,892.03
V55.2 Attention to Ileostomy
DRG 153Minor Small and Large Bowel Procedures without CCAverage National Payment $4,769.94
15% Incidence
CODINGREIMBURSE-MENT ANDCOST
CARE PATHDIAGRAM
PROCEDURECODING
PATIENTSCENARIOHISTORY
Point of Care Targeted by SeprafilmTM Point of Care Targeted by SeprafilmTM
38
© Premier Innovation Institute 2000. All rights reserved. These materials may not be reprinted or republished in any form without the express written consent of the Premier Innovation Institute.
AnastomoticProblems
AnastomoticProblems
OtherComplications
OtherComplications
Small BowelObstruction
Small BowelObstruction
A 24-year-old sales representative of a biotech company develops acute right lower quadrant pain. An upper GI/small bowel follow through subsequently shows 20 cm of inflammatory bowel disease in the terminal ileum to the ileosecal valve. The patient’s symptoms improve only slightly with medication until another acute episode occurs. A CT scan shows phegman in the right lower quadrant adjacent to the cecum. Exploration, ileocolic resection, drains, ileotransverse colon anastomosis and loop ileostomy. Patient discharged POD #9. Ileostomy is closed three months later. Adhesion is encountered and lysed. Patient is discharged on POD #7.
PATIENT WORKSHEET 6.2: CROHN’S DISEASE (REGIONAL ENTERITIS)
555.2 Regional Enteritis of Small Intestine with Large Intestine
Subsequent Procedures
Subsequent Procedures
SurgicalTreatmentSurgical
Treatment
InitialComplication
InitialComplication
DischargeDischarge
DischargeDischarge
DischargeDischarge
DischargeDischarge
Complication*Complication*
Complication*Complication*
Other DiseaseProcesses
Other DiseaseProcesses
PlannedSubsequent Procedures
PlannedSubsequent Procedures
SurgicalTreatmentSurgical
Treatment
SurgicalTreatmentSurgical
Treatment
MedicalTreatmentMedical
Treatment
Recurrence ofPrimary DiseaseRecurrence of
Primary Disease
PlannedSubsequent Procedures
PlannedSubsequent Procedures
27 PatientsALOS 8.76
$9,403 (Cost)
P 45.73 Right HemicolectomyS 46.01 Loop Ileostomy
Total Cost = $16,879
DRG 148Major Small and Large Bowel Procedures with CCAverage National Payment $13,892.03
15% Incidence
P 46.51 Closure Stoma small intestine S 54.59 Lysis of Adhesions
2 PatientsALOS5.6.50
$ 7,476 (Cost)
DRG 150Peritoneal Adhesiolysis without CCAverage National Payment $11,114.69
V55.2 Attention to Ileostomy
CODINGREIMBURSE-MENT ANDCOST
CARE PATHDIAGRAM
PROCEDURECODING
PATIENTSCENARIOHISTORY
Point of Care Targeted by SeprafilmTM Point of Care Targeted by SeprafilmTM
39
© Premier Innovation Institute 2000. All rights reserved. These materials may not be reprinted or republished in any form without the express written consent of the Premier Innovation Institute.
AnastomoticProblems
AnastomoticProblems
OtherComplications
OtherComplications
Small BowelObstruction
Small BowelObstruction
A 24-year-old sales representative of a biotech company develops acute right lower quadrant pain. An upper GI/small bowel follow through subsequently shows 20 cm of inflammatory bowel disease in the terminal ileum to the ileosecal valve. The patient’s symptoms improve only slightly with medication until another acute episode occurs. A CT scan shows phegman in the right lower quadrant adjacent to the cecum. Exploration, ileocolic resection, drains, ileotransverse colon anastomosis and loop ileostomy. Patient discharged POD #9. Ileostomy is closed three months later. Four days after procedure, patient develops nausea and abdominal distention. X-ray reveals partial small bowel obstruction. This is treated with NG suction and IV fluids. After 3 days distention resolved and patient is discharged on POD #8.
PATIENT WORKSHEET 6.3: CROHN’S DISEASE (REGIONAL ENTERITIS)
555.2 Regional Enteritis of Small Intestine with Large Intestine
Subsequent Procedures
Subsequent Procedures
SurgicalTreatmentSurgical
Treatment
InitialComplication
InitialComplication
DischargeDischarge
DischargeDischarge
DischargeDischarge
DischargeDischarge
Complication*Complication*
Complication*Complication*
Other DiseaseProcesses
Other DiseaseProcesses
PlannedSubsequent Procedures
PlannedSubsequent Procedures
SurgicalTreatmentSurgical
Treatment
SurgicalTreatmentSurgical
Treatment
MedicalTreatmentMedical
Treatment
Recurrence ofPrimary DiseaseRecurrence of
Primary Disease
PlannedSubsequent Procedures
PlannedSubsequent Procedures
27 PatientsALOS 8.76
$9,3040 (Cost)
P 45.73 Right HemicolectomyS 46.01 Loop Ileostomy
56 PatientsALOS 3.89
$4,693 (Cost)
46.51 Closure of Intestinal Stoma small intestine
Total Cost = $16,664
DRG 148Major Small and Large Bowel Procedures with CCAverage National Payment $13,892.03
V55.2 Attention to Ileostomy
DRG 153Minor Small and Large Bowel Procedures without CCAverage National Payment $4,769.94
15% Incidence
560.9 SBO
DRG 181GI Obstruction without CCAverage National Payment $2,133.64
657 PatinetsALOS 3.68
$2,568 (Cost)
P 96.07 Non operative Insert naso-gastric tube
$62.80 XRay
$396.79 IV TPN
$738 Antibiotics
$1,756 Other Meds
Pharm IV TPNPharm AntibioticsPharm Other MedsX-ray Plain Abd
(S800XR1000 )
(Tests/Meds already included in procedures)
CODINGREIMBURSE-MENT ANDCOST
CARE PATHDIAGRAM
PROCEDURECODING
PATIENTSCENARIOHISTORY
Point of Care Targeted by SeprafilmTM Point of Care Targeted by SeprafilmTM
40
© Premier Innovation Institute 2000. All rights reserved. These materials may not be reprinted or republished in any form without the express written consent of the Premier Innovation Institute.
AnastomoticProblems
AnastomoticProblems
OtherComplications
OtherComplications
Small BowelObstruction
Small BowelObstruction
A 24-year-old sales representative of a biotech company develops acute right lower quadrant pain. An upper GI/small bowel follow through subsequently shows 20 cm of inflammatory bowel disease in the terminal ileum to the ileosecal valve. The patient’s symptoms improve only slightly with medication until another acute episode occurs. A CT scan shows phegman in the right lower quadrant adjacent to the cecum. Exploration, ileocolic resection, drains, ileotransverse colon anastomosis and loop ileostomy. Patient discharged POD #9. Ileostomy is closed three months later. Seven days after procedure, patient experiences abdominal distention, nausea, and WBC 14,000. X-ray reveals small bowel obstruction and lysis of adhesion. Discharge POD #17.
PATIENT WORKSHEET 6.4: CROHN’S DISEASE (REGIONAL ENTERITIS)
555.2 Regional Enteritis of Small Intestine with Large Intestine
Subsequent Procedures
Subsequent Procedures
SurgicalTreatmentSurgical
Treatment
InitialComplication
InitialComplication
DischargeDischarge
DischargeDischarge
DischargeDischarge
DischargeDischarge
Complication*Complication*
Complication*Complication*
Other DiseaseProcesses
Other DiseaseProcesses
PlannedSubsequent Procedures
PlannedSubsequent Procedures
SurgicalTreatmentSurgical
Treatment
SurgicalTreatmentSurgical
Treatment
MedicalTreatmentMedical
Treatment
Recurrence ofPrimary DiseaseRecurrence of
Primary Disease
PlannedSubsequent Procedures
PlannedSubsequent Procedures
27 PatientsALOS 8.76
$9,403 (Cost)
P 45.73 Right HemicolectomyS 46.01 Loop Ileostomy
56 PatientsALOS 3.89
$4,693 (Cost)
46.51 Closure of Intestinal Stoma small intestine
Total Cost = $24,729
DRG 148Major Small and Large Bowel Procedures with CCAverage National Payment $13,892.03
V55.2 Attention to Ileostomy
DRG 153Minor Small and Large Bowel Procedures without CCAverage National Payment $4,769.94
15% Incidence
P 54.59 Lysis of Adhesions (Abdomen)
15 PatientsALOS 12.93
$10,633 (Cost)
DRG 150Peritoneal Adhesiolysis with CCAverage National Payment $11,114.69
P 560.9 Small Bowel Obstruction
CODINGREIMBURSE-MENT ANDCOST
CARE PATHDIAGRAM
PROCEDURECODING
PATIENTSCENARIOHISTORY
Point of Care Targeted by SeprafilmTM Point of Care Targeted by SeprafilmTM
41
© Premier Innovation Institute 2000. All rights reserved. These materials may not be reprinted or republished in any form without the express written consent of the Premier Innovation Institute.
Recurrence ofPrimary DiseaseRecurrence of
Primary Disease
PATIENT WORKSHEET 6.5: CROHN’S DISEASE (REGIONAL ENTERITIS)Five years after a first episode, the now 29-year-old vice president of sales develops nausea and vomiting with an obstructive picture. Recurrent disease with structuring found at the ileocolic anastomosis. Repeat ileocolic resection. ALOS is six days.
AnastomoticProblems
AnastomoticProblems
OtherComplications
OtherComplications
Small BowelObstruction
Small BowelObstruction
Subsequent Procedures
Subsequent Procedures
SurgicalTreatmentSurgical
Treatment
InitialComplication
InitialComplication
DischargeDischarge
DischargeDischarge
DischargeDischarge
DischargeDischarge
Complication*Complication*
Complication*Complication*
Other DiseaseProcesses
Other DiseaseProcesses
PlannedSubsequent Procedures
PlannedSubsequent Procedures
SurgicalTreatmentSurgical
Treatment
PlannedSubsequent Procedures
PlannedSubsequent Procedures
SurgicalTreatmentSurgical
Treatment
MedicalTreatmentMedical
Treatment
P 45.73 Right Hemicolectomy
6 PatientsALOS 5.83
$6,879 (Cost)
Total Cost = $6,879
DRG 149Major Small and Large Bowel Procedures without CCAverage National Payment $6,352.95
75-80% Incidence
555.2 Regional Enteritis of Small Intestine with Large Intestine
Recommended