Performance Measurement Network

Question: One Episode of Care and Thrombolytic Therapy Administration

We are a multi hospital system. When patients receive IV t-PA at one of our samller hospitals, they are transferred to our main hospital. This is considered "one episode of care", and abstracted and billed as such. Since the main hospital is the discharging hospital, all abstracted information is linked to the main hospital.

When answering the IV t-PA question we cannot answer 'Yes' because the IV t-PA was not administered at this hospital (the main hospital). Can we answer 'NC' because the IV t-PA was administered at another hospital or does the physician at the receiving hospital (main hospital) have to actually document that IV t-PA was not given because it was received at another hospital? Or, should we be answering the question 'Yes' because it is one episode of care? If we answer 'NC' we know that this t-PA patient will not be included in our t-PA denominator for either hospital because it is one episode of care.

Answer:

Per CMS guidance earlier this year (2009), if the case was billed as one claim then it should be abstracted as "one episode of care". This decision was made to ease data abstraction for hospitals.

When a patient receives IV t-PA at one acute care hospital and is then transferred to another acute care hospital within a single healthcare network (i.e. hospital system), the medical record can be viewed and abstracted as one episode of care. If the record is abstracted as one episode of care, the hospital billing for that episode of care should take credit for IV t-PA administration and select "Yes" for "IV Thrombolytic Therapy Administered".

Question Details
Focus area(s): Chart Abstracted Measure Specifications – Clinical
Related documents: STK,
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