Appendix. Costing Case Samples for OOHCA

Transcription

1 Appendix Costing Case Samples for OOHCA The patient (ICD-1) Treatment Codes (OPCS 4) Patient 27 Admitted to ICU following percutaneous cardiac intervention (PCI) with 2 drugeluting stents following a VF cardiac arrest. Treated with therapeutic hypothermia. Required further PCI with 2 more drug-eluting stents, an intraaortic balloon pump and a temporary pacing device one week after admission. Made a good recovery and was discharged to the ward after 34 days on ICU. Had an implantable cardioverter-defibrillator inserted prior to discharge home after 23 days on the ward. 1 I46 Cardiac arrest Cardiac arrest with successful resuscitation 2 I49 Other cardiac arrhythmias Ventricular fibrillation and flutter 3 I25 Chronic ischaemic heart disease Atherosclerotic heart disease 4 I447 Arterioventricular & left bundle branch block Left bundle branch block 5 N179 Acute renal failure Acute renal failure unspecified 6 I12 Hypertensive renal disease Hypertensive renal disease with renal failure 7 E78 Disorders of lipoprotein metabolism and other Pure hypercholesterolaemia 8 K573 Diverticular disease of intestine Diverticular disease of intestine without perf. 9 K529 Other non-infective gastroenteritis, colitis Non-infected gastroenteritis or colitis 1 J181 Pneumonia, organism unspecified Lobar pneumonia 11 Y95X Nosocomial condition Nosocomial condition 12 Z951 Presence of cardiac & vascular implants/grafts Presence of aortocoronoary bypass grafts 13 Z955 Presence of cardiac & vascular implants/grafts Presence of coronary angioplasty, implant or graft 14 Z95 Presence of cardiac & vascular implants/grafts Presence of cardiac pacemaker 1 K751 Percutaneous transluminal balloon angioplasty & insertion of 1-2 drug-eluting stents into coronary artery 2 Y534 Approach to organ under fluoroscopic control 3 X51 Direct current cardioversion 4 K751 Percutaneous transluminal balloon angioplasty and insertion of 1-2 drug-eluting stents into coronary artery 5 K561 Transluminal insertion of pulsation balloon into aorta 6 Y534 Approach to organ under fluoroscopic control 7 K61 Implantation of intravenous cardiac pacemaker system 8 Y75 Temporary operations 9 Y534 Approach to organ under fluoroscopic control 1 K65 Implantation of intravenous single chamber cardiac pacemaker system 11 Y534 Approach to organ under fluoroscopic control 12 H251 Diagnostic endoscopic examination of lower bowel & biopsy of lesion of lower bowel using fibreoptic

2 sigmoidoscope 13 Z286 (Operation) Sigmoid colon 14 U212 CT NEC 15 Y973 Radiology with post contrast 16 Y982 Radiology of 2 bone areas 17 Z926 (Operation) Abdomen NEC 18 Z927 (Operation) Trunk NEC 19 U212 MRI NEC 2 Y973 Radiology with post contrast 21 Y982 Radiology of 2 bone areas 22 Z926 (Operation) Abdomen NEC 23 Z927 (Operation) Trunk NEC Group EA12Z Implantation of cardioverter - defibrillator only XC3Z Adult critical care 4 organs supported Tariff EA12Z 5,86 (non-elective stay trimpoint 34 days MFF * 5,86 7,277 Additions XC3Z 1,717 * 33 days No additional days beyond trimpoint added ( 25/day) Implantable cardioverter defibrillator (ICD) 56,664 18,285 Reimbursements 82,226

3 The patient (ICD-1) Patient 69 Patient admitted to ICU following a VF out-of-hospital cardiac arrest secondary to stenosis of the LAD which was angioplastied. After therapeutic hypothermia made a good recovery but suffered further ischaemic episodes requiring further percutaneous cardiac intervention (PCI) and an intra-aortic balloon pump. Not all lesions identified amenable to PCI (2 bare metal stents inserted) and referred for cardiac bypass graft surgery. Underwent uneventful surgery after 52 days on ICU. Transferred to the care of neurosurgery for surgical evacuation of a spontaneous subdural haematoma diagnosed 2 days after cardiac surgery. Discharged to the ward after 19 more days on ICU for further recuperation and discharged home approximately 1 month later. 1 st Consultant Episode 1 I21 Acute myocardial infarction Acute transmural myocardial infarction 2 I1X 3 Z966 Presence of other functional implants Presence of orthopaedic joint implants 2 nd Consultant Episode 1 I251 Chronic ischaemic heart disease Atherosclerotic heart disease 2 I258 Chronic ischaemic heart disease Other forms of chronic ischaemic heart disease 3 I62 Other non-traumatic intracranial haemorrhage Subdural haemorrhage 4 I1X 5 Z921 Personal history of medical treatment Personal history long-term current (anticoagulants) 6 Z966 Presence of other functional implants Presence of orthopaedic joint implants 3 rd Consultant Episode 1 I62 Other non-traumatic intracranial haemorrhage Subdural haemorrhage 2 I258 Chronic ischaemic heart disease Other forms 3 J189 Pneumonia, organism unspecified Pneumonia unspecified 4 I48X Atrial fibrillation & flutter Atrial fibrillation & flutter 5 I1X 6 Z951 Presence of cardiac & vascular implants/grafts Presence of aortocoronoary bypass grafts Treatment Codes (OPCS 4) 1 st Consultant Episode 1 K753 Percutaneous transluminal balloon angioplasty & insertion of 1-2 stents into coronary artery 2 Y534 Approach to organ under fluoroscopic control 2 nd Consultant Episode 1 K43 Saphenous vein graft replacement of 3 coronary arteries 2 K611 Implantation of cardiac pacemaker system NEC 3 Y75 Temporary operations

4 4 Y731 Cardiopulmonary bypass 5 U51 CT head 6 Y981 Radiology of one body area 3 rd Consultant Episode 1 A411 Evacuation of subdural haematoma 2 Y462 Frontal open approach to contents of cranium 3 A113 Monitoring of pressure in tissue of brain 4 Y472 Frontal burrhole approach of contents of cranium 5 E423 Temporary tracheostomy 6 E851 Invasive ventilation HRG Group EA16Z Coronary artery bypass graft (first time) with percutaneous coronary intervention, pacing, EP or RFA XC3Z Adult critical care 3 organs supported XC4Z Adult critical care 4 organs supported Tariff EA16Z 15,835 (non-elective stay trimpoint 42 days) MFF * 15,835 19,663 Additions No additional bed days charged XC3Z 1,717 x 54 days XC4Z 1,554 x 19 days 92,723 29,53 Reimbursements 141,916

5 Patient 22 The patient Admitted to ICU after an out-of-hospital cardiac arrest secondary to hypoxia following an alcohol related seizure. Found to have suffered severe hypoxic brain injury on holding sedation. Died on ICU after life supporting measures were withdrawn after discussion with family. (ICD-1) 1 I469 Cardiac arrest, unspecified Cardiac arrest with successful resuscitation 2 G931 Other disorders of brain Anoxic brain damage, not elsewhere classified 3 F11 Mental behavioural disorders due to alcohol Harmful use 4 R568 Convulsions, not elsewhere specified Other and unspecified convulsions 5 N39 Other disorders of urinary system Urinary tract infection, site not specified 6 B962 Other bacterial agents as cause of disease E. coli as cause of disease Treatment Codes 1 E85.2 Non-invasive ventilation (OPCS 4) 2 U5.2 MRI head 3 Y98.1 Radiology of one body area 4 U5.1 CT head 5 Y98.1 Radiology of one body area HRG Group DZ37A Non-invasive ventilation support 19 years & over XC3Z Adult critical care 3 organs supported Tariff DZ37A 354 MFF * Additions No additional bed days applicable XC3Z 1,717 x 13 days 23,322 Reimbursements 23,762