Please see below: Do you consider do not resuscitate (DNR)? I got what is below from the AHRQ web site....I wonder if it is still current?
Date Published: February 28, 2011 Date Updated: June 1, 2012 The AHRQ QI do not currently consider do not resuscitate (DNR) as either a denominator exclusion or covariate in the risk-adjustment. We are however currently evaluating three relatively recent data elements related to hospice, palliative care and DNR. First, the UB-04 data element Point of Origin added a data value of “F” (Transfer from a Hospice Facility) in January 2010. Second, an ICD-9-CM diagnosis code V49.86 (Do not resuscitate status) was added October 1, 2010. Finally, the UB-04 data element Condition Code has a data value “P1” for “a DNR order was written at the time of or within the first 24 hours of the patient’s admission to the hospital and is clearly documented in the patient’s medical record”. The availability of HCUP data for 2010 will allow us to evaluate empirically one or more of these potential data elements alone or in combination as either an exclusion or covariate. As with any other potential patient characteristic, the empirical evaluation will focus on whether the characteristic is a mediator (and therefore a covariate) or moderator (and therefore a stratification or exclusion) of the quality of care. Although there is currently an ICD-9-CM diagnosis code (V66.7) for encounter for palliative care, the AHRQ QI do not incorporate the code in QI calculations because it does not specifically identify hospice care, can be applied at any time during a hospitalization (e.g., several weeks or months after admission), and is not yet reliably reported. See AHA Coding Clinic for ICD-9-CM, 3Q 2008, Volume 25(32):13-14: "This code may be reported for any terminally ill patient who receives palliative care, regardless as to when the decision is made. There is no time limit or minimum for the use of this code assignment." See also AHA Coding Clinic for ICD-9-CM, 1Q 1998, Volume 15(1):11: "Terms such as comfort care, end-of-life care, and hospice care are all synonymous with palliative care. These, or similar terms, need to be written in the record to support the use of code V66.7." In order for us to consider use of the V66.7 code, the coding guidance will need to be clarified or 5th digits must be included. We encourage professional societies with interest in this code to submit proposals to clarify the guidance William E. Haik, M.D.,F.C.C.P.,C.D.I.P. AHIMA Approved ICD-10-CM/PCS Trainer Office: (850) 863-2110 Cell: (850) 803-5854 Fax (850) 864-4438 In a message dated 6/19/2014 8:01:19 A.M. Central Daylight Time, [email protected] writes: When you report sepsis mortality rate (severe sepsis/septic shock), do you use any exclusions in your denominator such as DNR, Comfort care, refuse treatment, etc? Thank You Nenita Francisco, RN, BSN Director of Critical Care & Cardiovascular Unit Methodist Hospital 626 462-2758 This message, together with any attachments, is intended only for the use of the individual or entity to which it is addressed. It may contain information that is confidential and prohibited from disclosure. If you are not the intended recipient, you are hereby notified that any dissemination or copying of this message or any attachments is strictly prohibited. If you have received this message in error, please notify the original sender immediately by telephone or by return e-mail and delete this message, along with any attachments, from your computer. Thank you. ­­ _______________________________________________ Sepsisgroups mailing list [email protected] http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org
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