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Criteria for Inpatient Daily Care Level 5 Charge Spinal Cord Injury Patients (9.05)

Criteria for Inpatient Daily Care Level 5 Charge Spinal Cord Injury Patients (9.05) - Policies, Administrative, UWHC, Department Specific, Nursing Administrative, Patient Charges

9.05


UW HEALTH NURSING ADMINISRATIVE POLICY
Policy Title: Criteria for Inpatient Daily Care Level 5 Charge Spinal Cord Injury Patients
Policy Number: 9.05
Effective Date: October 24, 2017

1

As of October 24, 2017 this administrative policy applies to the operations and staff of legacy UWHC. Effective
July 1, 2015, the legacy operations and staff of UWHC and UWMF were integrated into the University of
Wisconsin Hospitals and Clinics Authority (UWHCA). All administrative policies are being transitioned to apply
UWHCA-wide, but until future revision to this policy #9.05, it applies only to the operations and staff of legacy
UWHC.


I. PURPOSE

A. Patients will be charged a higher rate for the initial admission or transfer to general care and acute
rehabilitation. Readmissions after completing an acute rehabilitation program would not be charged at the higher
rate. This rate applies only to new quadriplegics (C4-C8) placed in cost centers 93380 (Neurosciences), 93460 (Gen
Surg/Trauma) and 93520 (Acute Med/Progressive Care) and Children's Hospital 93410, 93480, and 93910 (general
care.)
B. This pertains to New Quadriplegia C4-C8 injuries. The C1-C3 injuries will be IMC/ICU status.

II. POLICY ELEMENTS

A. These patients require multiple nursing interventions as described below, and to qualify for the higher charge must
meet 3 or more or the following criteria:
i. Management of pulmonary system-includes any of the following
a. Multiple respiratory interventions (Intrapulmonary Percussive Ventilation (IPV), Intermittent Positive
Pressure Breathing (IPPB))
b. Intermittent Continuous Positive Airway Pressure (CPAP) treatment
c. Bi Pap
d. Artificial Airway
ii. Compromised ability to protect airway (any or all, A-C)
a. Risk of Aspiration
b. Dysphagia
c. Tracheostomies
iii. Compromised mobility (any or all, A - D)
a. Prevention of skin breakdown-turn could require rotational therapy or other therapies.
b. DVT Prophylaxis
c. Orthostatic hypo tension monitoring
d. Total dependence for all transfers/mobility
iv. Total dependence for all daily activities (any or all, A - D)
a. Bowel program
b. Bladder program
c. Feeding/Fluids
d. Activities of Daily Living (ADL’s)-Total dependence on all physical care
v. Specialized equipment beds, communication devices, adaptive aids call lights, phone (any or all.)

III. PROCEDURE

A. Upon admission:
i. If patient meets the criteria section listed above then they should receive a Daily Care Level 5 - Spinal Cord
Injury charge for the entire hospital stay. The admitting nurse will communicate to the Health Unit
Coordinator (HUC) the need to implement the Level 5 - Spinal Cord Injury daily care charge The HUC will
enter the Level 5 accommodation code into Health Link (HL) in order to change the daily care charge. The
correct accommodation code must be entered into the HL system before midnight of the day of admission in
order for the patient to receive the charge applicable to the first day of the stay. The charge remains in
effect until such time as patient is transferred or discharged.
ii. It is the responsibility of each Nurse Manager to specify which staff member is accountable for charge entry
when a HUC is not working. Generally, the task of assuring correct charges are reflected in the system will
be assigned to either the Care Team Leader or the admitting nurse when a HUC is not available. The
assigned staff member is responsible for entering the Level 5 accommodation code into Health Link


UW HEALTH NURSING ADMINISRATIVE POLICY
Policy Title: Criteria for Inpatient Daily Care Level 5 Charge Spinal Cord Injury Patients
Policy Number: 9.05
Effective Date: October 24, 2017

2

iii. The defining criteria for a level 5 spinal cord injury charge will be available 24/7 on uConnect for use by staff.
B. Days following admission date:
i. The Level 5 spinal cord injury charge will remain in effect throughout the patient stay.
ii. It is the responsibility of each Nurse Manager to specify which staff member is accountable for charge entry
when a HUC is not working. Generally, the task of assuring correct charges are reflected in the system will
be assigned to either the Care Team Leader or the admitting nurse when a HUC is not available. The
assigned staff member is responsible for entering the Level 5 accommodation code into Health Link
C. Daily patient charge review:
i. On a daily basis, the Nurse Manager or Manager’s delegate (e.g. Care Team Leader/Charge Nurse/Senior
Team Member (STM) or Health Unit Coordinator) is responsible for reviewing all active charges before
midnight and for assuring that all patient charges are correct for the midnight charge capture. Data pertinent
to the daily care patient charges can be found in either the home page patient list or the unit census
snapshot report in Health Link.
ii. On a daily basis, the Manager or Manager’s delegate (e.g. Care Team Leader/Charge Nurse/STM or Health
Unit Coordinator) must review the Daily Activity Journal report (DAJ) which lists all charges posted for a
patient the previous midnight. A comparison of the DAJ with the unit census snapshot run for the previous
24 hours will be conducted. Any patient charge errors discovered as a result of this review will be corrected
immediately. If the patient is not yet discharged, corrections can be made in Health Link by the unit staff. If
the patient has been discharged by the time the error is discovered, the unit staff will notify the Admissions
Department. Admissions will then correct the charge error when feasible to do so.

IV. COORDINATION

Author: Director, Nursing Finance & Staffing Effectiveness
Reviewers: Manager, Charge Capture
Nursing Administrative Policy & Procedure Committee Approval: September 18, 2017

UW Health is a cohesive, united and integrated academic medical enterprise comprised of several entities. This
policy applies to facilities and programs operated by the University of Wisconsin Hospitals and Clinics and the
University of Wisconsin Medical Foundation, Inc., and to clinical facilities and programs administered by the
University of Wisconsin School of Medicine and Public Health. Each entity is responsible for enforcement of this
policy in relation to the facilities and programs that it operates.

V. APPROVAL

Beth Houlahan DNP, RN, CENP
Senior Vice President, Chief Nurse Executive

VI. REVIEW DETAILS

Version: Revision
Last Full Review: September 18, 2017
Next Revision Due: September 2020