Patient Safety Initiative - Case Review System

Definitions of Terms

 

Adverse Event An injury caused by medical management rather than by the underlying disease or condition, not necessarily due to an error
CMS Hospital-Acquired Conditions A combination of “never events” and adverse events that the Centers for Medicare and Medicaid Services have targeted for a reduction in Medicare reimbursement. If one of these conditions is coded in the hospital bill as an ICD-9-CM diagnosis code that was acquired during hospitalization, it will be stripped from the hospital bill during the payment process, which may cause a reduction in reimbursement.
Contributing Factors Potential reasons that an event has occurred.
Final Disposition An action step that is taken or recommended for the purpose of sharing the findings of a case investigation for education, quality improvement or peer review.
ICD-9-CM Diagnosis; ICD-9-CM Procedure International Classification of Diseases 9th Revision Clinical Modification provides a catalog of diagnosis and procedure codes. These are the codes that experts from Health Information Management assign for each discharged patient in the hospital bill that is submitted to third party payors.
Present on Admission (PoA) Indicator A value that hospital coding experts assign to each ICD-9-CM diagnosis code that indicates whether it was present on admission (pre-existing), acquired during hospitalization or exempt from being assigned a PoA value
ICD-9-CM Diagnosis Code Suffix “NEC” NEC is an abbreviation for “not elsewhere classified” and is used to denote an ICD-9-CM diagnosis code that is more general or non-specific than other possible codes that could have been used to describe the condition.
ICD-9-CM Diagnosis Code Suffix “NOS” NOS is an abbreviation for “not otherwise specified” and is used to denote an ICD-9-CM diagnosis code that is more general or non-specific than other possible codes that could have been used to describe the condition.

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