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Kamal Gupta - One of the best experts on this subject based on the ideXlab platform.
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Abstract 17294: Outcomes of ECMO Use in Cardiogenic Shock: Analysis From the Nationwide Readmissions Database
Circulation, 2020Co-Authors: Prakash Acharya, Abdulelah Nuqali, Sagar Ranka, Zubair Shah, Kamal GuptaAbstract:Introduction: Extracorporeal membrane oxygenation (ECMO) is being increasingly used for acute support in patients with cardiogenic shock (CS). Data regarding the indications, outcomes, and readmissions in these patients from a nationally representative sample is lacking. Methods: A secondary analysis of the Nationwide Readmission Database for years 2016-2017 was performed. Patients who were admitted with a primary diagnosis of CS were identified using ICD-10, Clinical Modification codes and were sub-grouped into those with acute coronary syndrome (ACS) and without ACS (non-ACS). Any readmission within 30 days of discharge was considered for analysis. Results: A total of 6,126 patients with CS received ECMO support, among which 35% had concurrent acute coronary syndrome (ACS). Patients on ECMO who had ACS were significantly older (60.5±11 vs 45.1±11 years, p<0.001) compared to non-ACS patients. Time to ECMO placement was also significantly shorter in ACS patients (3.4±5 vs 6.9±15 days, p<0.001). There was no difference in complications during index admission including vascular complications and stroke among the two groups. The length of index hospitalization was longer in the non-ACS group (32.8±36 vs 19.6±22.9 days, p<0.001) whereas mortality was significantly higher in patients with ACS (58.21 vs 49.55%, p<0.001). Every decade increase in the age above 50 years significantly increased odds of mortality in the non-ACS group whereas in the ACS group, mortality increased significantly only when the age is over 70 years [HR 2.32, CI(1.35-3.99), p=0.002]. The rate of readmission among patients who survived to discharge was 18.2% (17.3% in ACS group vs 18.9% in non-ACS group, p=0.35). The most common primary causes of readmission were local complications from ECMO placement (7.65%), CHF, (6.5%), sepsis (6.5%), critical illness poly-myopathy/neuropathy (2.9%) and stroke (1.46%). The mortality during readmission was 8.2%. Conclusions: Only 1 in every 2 patients with CS on ECMO survives to discharge. Survival to discharge in these patients differs significantly according to the presence or absence of ACS. Among the patients who survive to discharge, 18% of patients are readmitted within 30 days.
Shannon Fogh - One of the best experts on this subject based on the ideXlab platform.
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Looking Ahead: Practicing Radiation Oncology in the Era of ICD-10
International Journal of Radiation Oncology*Biology*Physics, 2015Co-Authors: Lisa Singer, Steve Braunstein, Shannon FoghAbstract:For over 30 years, the International Statistical Classification of Diseases and Related Health Problems, 9th edition (ICD9) has provided a framework for medical coding in the United States (1). Beginning October 1, 2015, physicians in the United States are required to begin using the updated, more complex version of this framework for the coding of morbidity: International Statistical Classification of Diseases and Related Health Problems, 10th edition (ICD-10). This much-anticipated transition has already occurred in many countries, and as the implementation date has now arrived in the United States, we summarize the changes specific to radiation oncology, highlight implications for future practice and research, and suggest useful references for radiation oncologists. The World Health Organization has been updating the ICD since 1948 (2). ICD-10 represents the 10th edition of this infrastructure. In the United States, ICD-10 was adopted for mortality coding in 1999 (3), but ICD-9 has continued to provide a framework for morbidity coding. The United States adopted 2 versions of ICD-10 on October 1, 2015: ICD-10 Clinical Modification (ICD-10CM), a set of inpatient and outpatient diagnostic codes, replacing ICD-9-CM Volumes 1 and 2, and ICD-10 Procedure Coding System (ICD-10-PCS), a set of inpatient procedure codes, replacing ICD-9-CM Volume 3. The Current Procedural Terminology (CPT) codes assigned to outpatient procedures are not a part of this transition (4). Collectively, ICD-10-CM and ICD-10-PCS will have an impact on diagnostic and procedural coding for all
Prakash Acharya - One of the best experts on this subject based on the ideXlab platform.
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Abstract 17294: Outcomes of ECMO Use in Cardiogenic Shock: Analysis From the Nationwide Readmissions Database
Circulation, 2020Co-Authors: Prakash Acharya, Abdulelah Nuqali, Sagar Ranka, Zubair Shah, Kamal GuptaAbstract:Introduction: Extracorporeal membrane oxygenation (ECMO) is being increasingly used for acute support in patients with cardiogenic shock (CS). Data regarding the indications, outcomes, and readmissions in these patients from a nationally representative sample is lacking. Methods: A secondary analysis of the Nationwide Readmission Database for years 2016-2017 was performed. Patients who were admitted with a primary diagnosis of CS were identified using ICD-10, Clinical Modification codes and were sub-grouped into those with acute coronary syndrome (ACS) and without ACS (non-ACS). Any readmission within 30 days of discharge was considered for analysis. Results: A total of 6,126 patients with CS received ECMO support, among which 35% had concurrent acute coronary syndrome (ACS). Patients on ECMO who had ACS were significantly older (60.5±11 vs 45.1±11 years, p<0.001) compared to non-ACS patients. Time to ECMO placement was also significantly shorter in ACS patients (3.4±5 vs 6.9±15 days, p<0.001). There was no difference in complications during index admission including vascular complications and stroke among the two groups. The length of index hospitalization was longer in the non-ACS group (32.8±36 vs 19.6±22.9 days, p<0.001) whereas mortality was significantly higher in patients with ACS (58.21 vs 49.55%, p<0.001). Every decade increase in the age above 50 years significantly increased odds of mortality in the non-ACS group whereas in the ACS group, mortality increased significantly only when the age is over 70 years [HR 2.32, CI(1.35-3.99), p=0.002]. The rate of readmission among patients who survived to discharge was 18.2% (17.3% in ACS group vs 18.9% in non-ACS group, p=0.35). The most common primary causes of readmission were local complications from ECMO placement (7.65%), CHF, (6.5%), sepsis (6.5%), critical illness poly-myopathy/neuropathy (2.9%) and stroke (1.46%). The mortality during readmission was 8.2%. Conclusions: Only 1 in every 2 patients with CS on ECMO survives to discharge. Survival to discharge in these patients differs significantly according to the presence or absence of ACS. Among the patients who survive to discharge, 18% of patients are readmitted within 30 days.
Ranjan Sachdev - One of the best experts on this subject based on the ideXlab platform.
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Getting Ready for ICD-10 and Meaningful Use Stage 2.
Instructional course lectures, 2016Co-Authors: Jack M. Bert, William R. Beach, Louis F. Mcintyre, Ranjan SachdevAbstract:For the past 24 years, most developed countries have used the International Classification of Diseases, Tenth Revision (ICD-10) to report physician services. In the United States, physicians have continued to use the American Medical Association Current Procedural Terminology, Fourth Edition and the Healthcare Common Procedure Coding System. The ICD-10-Clinical Modification (CM) has approximately 4.9 times more codes than the International Classification of Diseases, Ninth Revision. ICD-10-CM allows for more specific descriptors of a procedure and is broken down by category, etiology, anatomic site, severity, and extension. ICD-10-CM is scheduled to be implemented by Medicare and commercial payers on October 1, 2015. In addition to ICD-10 implementation, physicians have to meet the requirements of the Meaningful Use Electronic Health Record Incentive Program. The Meaningful Use program is designed to promote the use of certified electronic health technology by providing eligible professionals with incentive payments if they meet the defined core and menu objectives of each stage of the program. All core measures must be met; however, providers can choose to meet a preset number of menu measures. Meaningful Use Stage 1 required eligible professionals to meet core and menu objectives that focused on data capture and sharing. Meaningful Use Stage 2 requires eligible professionals to meet core and menu objects that focus on advanced Clinical processes for a full year in 2015. Stage 3 has been delayed until 2017, and core and menu measures that will focus on improving outcomes have not yet been defined. It is important for orthopaedic surgeons to understand the history of and techniques for the use of ICD-10-CM in Clinical practice. Orthopaedic surgeons also should understand the requirements for Meaningful Use Stages 1 and 2, including the core objectives that must be met to achieve satisfactory attestation.
Rob J. Th. Ouwendijk - One of the best experts on this subject based on the ideXlab platform.
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Gastrointestinal Endoscopic Terminology Coding (GET-C): A WHO-Approved Extension of the ICD-10
Digestive Diseases and Sciences, 2007Co-Authors: Marcel J. M. Groenen, Willem Hirs, Henk Becker, Ernst J. Kuipers, Gerard P. Berge Henegouwen, Paul Fockens, Rob J. Th. OuwendijkAbstract:Technological developments have greatly promoted interest in the use of computer systems for recording findings and images at endoscopy and creating databases. The aim of this study was to develop a comprehensive WHO-approved code system for gastrointestinal endoscopic terminology. The International Classification of Diseases, 10th edition (ICD-10), and the ICD-10 Clinical Modification (ICD-10-CM) were expanded to allow description of every possible gastrointestinal endoscopic term under conditions defined by the WHO. Classifications of specific gastrointestinal disorders and endoscopic locations were added. A new chapter was developed for frequently used terminology that could not be classified in the existing ICD-10, such as descriptions of therapeutic procedures. The new extended code system was named Gastrointestinal Endoscopic Terminology Coding (GET-C). The GET-C is a complete ICD-10-related code system that can be used within every endoscopic database program for all specific endoscopic terms. The GET-C is available for free at http://www.trans-it.org/.
