MDC 24

Objectives

Gain a practical understanding of principles governing Multiple

Significant Trauma under the MS-DRG system

Recognize clinical clues, signs and symptoms of specific

disease entities subject to unrecognized opportunities for
clinical clarification during the chart review process

Learn how to practically apply underlying principles of Multiple

Significant Trauma through use of case studies as part of the
presentation

Presented by;

Kathy Thomas, RN Clinical Documentation Specialist, Wheaton Franciscan Health Care

Elmbrook Memorial

Renee Hedtcke, RN, CCDS, Aurora Medical Center Summit

MST Surgical DRG

955 Craniotomy

956 Limb Reattachment,

hip or femur procedure

RW 5.4529

RW 3.6322

ALO

ALOS

957 Other OR procedures w/ MCC RW 6.6017 ALOS 14

958
w/CC
RW 3.7491 A
959
w/o CC/MCC
RW 2.4711 ALOS

DEFINITION OF TRAUMA
Refers to "wound" body wound/shock produced by sudden
physical injury from accident or violence>>>major trauma.
This can result in secondary complications;

shock/failure/d

Treatment of the trauma patient often involves multiple manag

What Qualifies for

MST
PDX from Trauma
Diagnosis List
AND
body sites

2 additional

_____________
OR
____________

PDX from 1 body

site
& 1 additional

Trauma Diagnosis List

Less severe and do not qualify as a body site

Examples:

Closed or open skull fractures with no or unspecified LOC, or w/ co

Concussion w/ no LOC, unspecified, or LOC < 1 hr
Vertebral fracture, open or closed, without spinal cord injury
Rib fractures - closed, 6 or less, or unspecified
Rib fractures - open, 3 or less, or unspecified
Sternum, clavicle, or scapula - closed fracture

Trauma Diagnosis List, cont

Closed Fractures of upper or lower extremity
Dislocations, open or closed
(except open hip, knee, ankle, shoulder, elbow)
Sprains or strains
Open wounds

Traumatic amputation of thumb, fingers or toes (complete or p

Trauma Diagnosis List, cont

Injury to blood vessels

Superficial injuries
Contusions
Injury to nerves

Complications of trauma, secondary and recurrent hemorrhag

Posttraumatic wound infection NEC
Injury, other and unspecified

Body Site
Categories

MST 1

Head

MST 2

Chest

MST 3

Abdomen

MST 4

Kidney Adrenal

MST 5

Urinary Pelvic

MST 6

Pelvis Spine

MST 7

Upper Limb

MST 8

Lower Limb

MST 1

Head

LOC
brief less than 1 hr
LOC or Concussion
moderate 1-24 hrs
prolonged, >24 hrs
unspecified

Intercranial injury
Skull or multiple facial fractures, open or closed,
w/cerebral lac
intercranial hemorrhage
Cerebral laceration and contusion
Injury to carotid artery, jugular vein, or multi
blood
vessels of head/neck

MST 2

Chest

Rib fractures: Closed, 7 or more

Open, 4 or more
Sternum, open fracture or open dislocation
Traumatic pneumothorax or hemothorax
Injury to heart and lung (heart and lung contusion)
Injuries to thoracic blood vessels, subclavian veins,
superior vena cava, thoracic aorta
Complications of trauma, air or fat embolism

MST 3

Abdomen

Injury with or without open wound to:

Stomach, Small intestine, colon, rectum, pancreas,
bile duct and gall bladder, other GI sites
Injury to appendix w/o mention of open wound
Injury to Liver or spleen
Injury to other GI sites, without mention of open
wound into cavity: ie traumatic insertion of NG tube
Injury to blood vessels of the abdomen and pelvis

MST 4

Kidney

Injury to kidney
Injury to adrenal gland w/ or w/o mention
of open wound

MST 5

Urinary

Injury to pelvic organs (bladder, urethra, ureter, uterus)

[includes traumatic removal or insertion of foley]

MST 6

Pelvis and Spine

Fracture of vertebral column, open or closed, with

spinal cord injury
Fracture of vertebral column, sacrum, and coccyx open or
closed, without spinal cord injury
Or unspecified spinal cord injury
Dislocation of vertebra open, cervical open or closed
Spinal cord injury w/o evidence of spinal bone injury
Injury to nerve roots

MST 7

Upper Limb

Open fractures of bones of the arm

Open dislocation of shoulder or elbow
Traumatic amputation of arm and hand (complete or partial)
Injury to blood vessels of UE
Injury to nerves (brachial plexus, axillary, median,
ulnar, radial)

MST 8 Lower Limb

Fracture of femur (open or closed)
Multi fx LE w/ UE, both LE, LE w/ sternum
Open dislocation of hip, knee, or ankle
Traumatic amputation of foot or leg (complete or partial)
Injury to femoral artery, femoral veins, popliteal
or tibial blood vessels
Or other specified blood vessels of LE

CLASSIFICATIONSTrauma can be classified by the affecte

*
*
*
*

HEAD INJURY (30%)

CHEST TRAUMA (20%)
ABDOMINAL TRAUMA (10%)
EXTREMITY TRAUMA (2%)

THINGS TO THINK ABOUT:If Polytrauma is 40% of injuries; why are there not
* Use your clinical expertise >does the patient look sicker than thedocumen
* Are the results of diagnostics appropriately and clearly documented?
* Are query opportunities identified?
* Are suspected conditions confirmed or ruled out?

* secondary conditions effecting level of care and resource consumptiondoc

THINGS TO THINK ABOUT

* missed injury? not found during initial assessment but manifested
later?(ie: traumatic foley insertion or removal could change the DRG to
MST)
* did the patient require one or more surgical interventions?
* EMT treatment/survey life threatening injury
* ED treatments/survey Complete inspection, systemic assessment
* Consults
* Diagnostics: CT, Xray, MRI
* Labs: Hematuria, ABGs, CBC, Blood sugar elevation
* Procedures: paracentesis, pericardiaocentesis

*** All injuries do not have to be POA

Pt pulling out their foley causing urethral trauma, or
Traumatic insertion of an NG tube causing injury.
Any injury from a fall while in the hospital
would not count as an MST qualifying injury.
***Additional injuries beyond qualifying for the MST DRG
DO NOT count as CC/MCCs

Possible CCs with MST

Acute Renal Failure
Acute Blood Loss Anemia
Atelectasis

Possible MCCs with MST

Pneumonia
Respiratory Failure
Respiratory Arrest
Cardiac Arrest
Shock Hypovolemic, hemorrhagic,
traumatic

PE
Quadriplegia

Possible Query opportunities if MST is suspect

Clarify LOC and the duration

Clarify the number of rib fractures
If there is broken skin consider clarifying:
Open or closed fractures
Open or closed dislocation
Laceration to underlying organ
If there is a contusion/ hematoma, blood transfusion,
spreading ecchymosis, drop in H/H, fractured bone consider:
Injury to blood vessel
Contusion or laceration to underlying organ
Brain contusion (851)
Heart or lung contusion (861)
Injury to Liver
Injury to Spleen