- Okay, Good afternoon, everyone, I'm Jill McArdle;
I'm going to be rapidly firing through
Section J, health conditions.
At the end of this session,
I would like to achieve these objectives;
we're going to be defining,
going over the definition of section J, health conditions.
Falls is the only health condition under Section J.
This is a new item for the LTCH Care Data Set version 3.0,
so you may want to pay particular attention.
I'm going to explain the intent of Section J,
discuss the coding instructions,
and also we're going to go through
a few practice scenarios,
and since I love competition,
I'm going to give you a heads up.
You're going the need the zero, the one, and the two
in order to work through these scenarios, so get ready!
So, again, this is a new section.
All items under this section are new.
And the items include J1800,
which is any fall since admission,
and J1900, the number of falls since admission
and the injury associated with the fall.
So you should feel pretty good
at the end of these practice scenarios,
because I think you're going get them right
after we review the definition of what constitutes a fall,
and then what constitutes an injury as it relates to a fall.
So the intent of this session is--
or this section is rather obvious.
These items are intended to code any fall since admission,
in addition to any injury caused by the fall.
So, this is what J1800 looks like.
And the question reads:
Has the patient had any fall since admission?
By the way, the Section J,
you will be collecting this information
on the planned discharge, the unplanned discharge,
and the expired assessment.
So the rationale for item J1800,
falls are a leading cause of morbidity and mortality
in the long-term care patient population.
Fear of falling can limit an individual's activity,
and negatively impact one's quality of life.
You can imagine the negative consequences of a fall,
how that might impact someone.
The unintentional--
so this is the definition of a fall,
so this is where you should pay particular attention.
This is going to be the standard definition
of what constitutes a fall.
So it's, the unintentional change in position
coming to rest on the ground, floor,
or onto the next lower surface,
which might be onto a bed, or a chair, a bedside mat;
so it's an unintentional change in position
coming to rest on the ground, floor,
or onto the next lower surface.
A fall may be witnessed-- this is also very important.
A fall may be witnessed, reported by the patient,
or an observer, or identified when a patient
is found on the floor or ground.
So, even an unwitnessed fall is considered to be a fall.
Falls are not a result of an overwhelming force.
So if another patient pushes a patient that is not a fall.
And an intercepted fall,
that's another key component of the definition,
an intercepted fall occurs when the patient would have fallen,
if he or she had not caught him or herself
or had not been intercepted by another person.
This is still considered a fall.
So, an intercepted fall is still considered to be a fall.
You'll need that in the coding scenario, FYI.
So the recommended components of the medical record
that you should review in order to capture J1800
include the physician, nursing, therapy,
nursing assistant notes, incident reports, and fall logs.
Again, the coding instructions for J1800,
you'll be asking yourself the question,
has the patient had a fall since admission?
Again, the three assessments
that this will be captured under,
include planned discharge assessment,
unplanned discharge assessment, and expired assessment.
And you'll either code 0, or 1.
0, indicating that the patient has not had a fall
based on the definition that we just reviewed,
or yes, the patient did have a fall.
If you code 0, you'll be directed to a skip pattern
on the various assessments.
And if you code 1, you'll be asked to answer J1900.
So, here's your first coding scenario.
So get your cards ready.
So, an incident report describes an event
in which Mr. S was walking down the hall
and appeared to slip on a wet spot on the floor.
He lost his balance, and bumped into the wall,
but was able to grab onto the handrail
and steady himself.
So, remember, you have two choices, 0 or 1,
0 indicating he did not fall,
1 indicating he fell.
I see kind of a mixed response rate here.
A lot of ones.
And one is the correct answer.
You would answer yes, there was a fall
because, an intercepted fall is considered a fall.
Does that make sense to everyone?
Okay.
The next section is J1900.
This is where we start capturing the type of fall.
So there are three parts of J1900, A, B, and C,
and we'll be going over each of those.
Again, we're reporting the number of falls since admission
and the type of fall.
We're categorizing the falls.
It applies, again, to the planned discharge,
unplanned discharge, and expired assessments.
You should review this same areas of the medical record
for that, which you reviewed for J1800, the physician notes,
nursing, therapy, nursing assistant notes,
incident reports, and falls log.
So this is what J1900 looks like.
The coding instructions are here.
And the one thing I wanted to point out here
on this particular slide
is that you are to determine the number of falls
that occurred since admission,
and code the level of fall related injury for each fall.
Code each fall, only once. Code each fall only once,
and if the patient has multiple injuries in a single fall,
code the fall with the highest level of injury,
so just bold it,
italic line there is very important.
If the patient has multiple injuries in a single fall,
you're to code the fall at the highest level of injury.
So I'm going to go through a couple of definitions,
these are the standard definitions
to describe whether there was an injury related to a fall.
So the first is injury related to fall.
This is defined as any documented injury
that occurred as a result of,
or was recognized within a short period of time,
hours to a few days, after the fall
and attributed to the fall.
So that is the definition of "injury."
J1900A, the coding instructions,
you'll need your cards to answer this scenarios;
I told you it was either going to be, 0, 1, or 2:
0 indicates none,
if the patient had no injurious falls since admission;
1, if the patient had one non-injurious fall
since admission;
and 2, indicating two or more, injurious falls since admission.
So, the next definition.
This is for J1900B, is injury except major.
So, injury except major includes skin tears, abrasions,
lacerations, superficial bruises, hematomas, and sprains,
or any fall-related injury
that causes the patient to complain of pain.
Coding instructions are the same:
0, indicating none, if the patient
had no injurious fall except major, since admission;
1, if there was one injurious fall except major;
and 2, two or more injurious falls except major.
So, just similar to J1900A.
So, the last definition here for J1900C is major injury;
definition of a major injury includes bone fractures,
joint dislocations, and closed head injuries
with altered consciousness, and subdural hematoma.
Coding instructions are the Same: 0, none;
1 for one; and 2 for two or more.
So let's try these scenarios here, practice scenarios.
So if we could have your enthusiastic participation here.
So, the first scenario reads as such.
A nursing note states
that Mrs. K slipped out of her wheelchair
onto the floor during transfer from bed to the wheelchair.
Before being assisted back into her bed,
an assessment was completed that indicated no injury.
So you are to code 1900A, the choices are 0, 1, or 2.
Did Mrs. K have a fall, and what type of fall was it?
Hold your--
[LAUGHTER] somebody's holding up more than one choice there.
That's not fair.
Okay. There's a lot of ones.
This is great. You guys are getting this.
So this is J1900A, would be coded 1.
Slipping onto the floor is considered a fall,
and there was no injury indicated.
Here's another softball scenario for you.
I think you're gonna get this one.
The scenario reads; a nurse's note describes a patient
who climbed over his bedrail and fell to the floor.
On examination, he had a cut over his left eye
and some swelling on his arm.
He was sent to the emergency room,
where x-rays revealed no injury,
and neurological checks
revealed no changes in mental status.
The patient returned to the facility within 24 hours.
He had a cut over his left eye, some swelling in his arm.
How would you code J1900B?
0, 1, or 2?
Don't be shy there.
Okay.
The majority, it looks like everyone, in fact,
has coded it 1 which is correct.
Very good.
Lacerations and swelling are considered
to be an injurious fall except major,
so that was coded correctly.
The last scenario is;
a patient fell, this is under J1900C,
to determine whether there was a major injury
associated with the fall.
So the scenario is,
a patient fell, lacerated her head,
and was sent to the emergency room,
where a head CT scan revealed a subdural hematoma.
The patient received treatment
and returned to the facility after two days.
The choices are 0, 1, and 2.
Did this patient have a major injury associated with a fall?
And very good.
That is correct.
We coded 1, because a subdural hematoma,
of course, is a major injury.
So, just in summary-- right on time here.
Just remember all of Section J is new.
It captures any falls since admission,
and then, you are to record whether the fall,
there was an injury associated with the fall.
It applies to these assessments, the planned discharge,
unplanned discharge, and expired assessment,
and as your homework or action items
when you get back to your facility,
probably want to educate your staff about Section J,
since this is a new section.
This is a great opportunity to review your policies
and procedures as they relate to fall reduction, prevention,
and also consider how you are documenting falls
and categorizing falls.
Make sure your definitions
meet the standards that are described,
so that you can ensure accurate data collection.
And then, of course, use some of the practice scenarios
with your staff.
So thank you for your enthusiastic participation
in Section J.
And good luck to you.