Q&A: Triggering PSI 15 with NG tube placement
Q: For those patients who are flagging due to a procedure unrelated to the first, what do you do with those? If the issue is found during the surgery and taken care of, they don’t require a trip back to the operating room, but the patient then needs an NG tube to drain their stomach, and it’s now flagging for PSI 15. What should we do in these cases?
A: This seems to be an issue for many organizations. PSI 15 was meant to capture the worst events, but code 0D9970Z, Drainage of duodenum with drainage device via natural or artificial opening, is a PCS code listed for inclusion for PSI 15. The patient would need to have a coded accidental tear or laceration coded as well as the PCS codes for abdominal/pelvic surgery. Which brings us back to the question of whether we report a serosal tear that did not change the course of care or the course of the surgery.
I do believe I have found a much easier solution to this specific reporting problem, and it comes from an example from the Coding Clinic.
Per the Coding Clinic, insertion of nasogastric tube for drainage and feeding, second quarter 2015, p. 29 (bold added):
Question:
A nasogastric (NG) tube was inserted for drainage. The next day, tube feedings were ordered using the existing NG tube. What is the correct root operation(s) for the insertion of a single NG tube used for drainage and feeding?
Answer:
The placement of a nasogastric tube does not need to be coded in the inpatient setting. However, for facilities that wish to collect this information, assign the following ICD-10-PCS codes:
0D9670Z
Drainage of stomach with drainage device, via natural or artificial opening
3E0G76Z
Introduction of nutritional substance into upper GI, via natural or artificial opening
My advice is to work with your coding team and develop guidelines within your organization. As instructed by Coding Clinic, this PCS code does not need to be coded for the inpatient setting, so coders are not required to capture it. This should eliminate triggering PSI 15 due to an NG tube placement.
Editor’s note: Kim Conner, BSN, CCDS, CCDS-O, CDI education specialist for ACDIS/HCPro based in Middleton, Massachusetts, answered this question. Contact her at kconner@hcpro.com.