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Criteria for Inpatient Daily Care Level 5 Charge - Adult Inpatient Tracheostomy Patients (9.09)

Criteria for Inpatient Daily Care Level 5 Charge - Adult Inpatient Tracheostomy Patients (9.09) - Policies, Administrative, UWHC, Department Specific, Nursing Administrative, Patient Charges

9.09

POLICY & PROCEDURE





Effective Date:
November 17, 2015

Administrative Manual
 Nursing Manual
 Other _______________

Policy #:
9.09

Original
Revision

Page 1
Of 3

Title: Criteria for Inpatient Daily Care Level
5 Charge – Adult Inpatient Tracheostomy
Patients



I. PURPOSE:
A. Patients will be charged a higher daily care rate when they are admitted to selected
inpatient units and meet certain criteria as specified in the Policy section below.
II. POLICY:
A. This Daily Care Level 5 Adult Tracheostomy charge applies primarily to
Gyn/Uro/Plastics/ENT (93610), Acute Medical Progressive Care Unit (93520), Surgical
Trauma (93460), Neurosciences (93380), Neuro ICU (93390), and Cardiothoracic
Surgery (93570) inpatient units. These patients require multiple nursing interventions as
described below, and to qualify for the higher charge must have a Tracheostomy and meet
2 or more or the following criteria:
1. Compromised ability to protect airway relating to cognitive impairment (traumatic
brain injury, developmental delay, alcohol/drug related-may include active alcohol
withdrawal, dementia)
2. Compromised ability to protect airway due to copious and thick secretions that
could result in airway occlusion from a mucous plug
3. Requires tracheostomy care and/or suctioning every 2 hours or more frequently
4. Requires continuous pulse oximetry monitoring
5. Requires vital signs every 2 hours or more frequently
6. Requires serial hematocrit monitoring
7. Requires concurrent flap surgery that requires monitoring every 2 hours or more
frequently
II. PROCEDURE:
A. Upon Admission:
1. If patient meets the criteria section listed above then they should receive an
Inpatient Daily Care Level 5 - Tracheostomy charge until such time as the charge
criteria is no longer met. The admitting nurse communicates to the Health Unit
Coordinator (HUC) or Patient Care Technician (PCT) the need to implement the
Level 5 daily care charge. The HUC/PCT will enter the level 5 accommodation
code into the Electronic Medical Record (EMR) in order to change the daily care
charge. The correct accommodation code must be entered into the EMR system
before midnight on the day of admission in order for the patient to receive the
charge applicable to the first day of the stay.
2. It is the responsibility of each Nurse Manager (NM) to specify which staff

POLICY & PROCEDURE





Effective Date:
November 17, 2015

Administrative Manual
 Nursing Manual
 Other _______________

Policy #:
9.09

Original
Revision

Page 2
Of 3

Title: Criteria for Inpatient Daily Care Level
5 Charge – Adult Inpatient Tracheostomy
Patients



member is accountable for charge entry when a HU/PCT is not working.
Generally, the task of assuring correct charges are reflected in the system will be
assigned to either the Care Team Leader (CTL) or the admitting nurse when a
HUC/PCT is not available. The assigned staff member is responsible for entering
the Level 5 accommodation code into the EMR.
3. The defining criteria for a level 5 Adult Tracheostomy charge will be available
24/7 on uConnect for use by staff.
B. Days following admission date:
1. The Level 5 Adult Tracheostomy charge is evaluated for appropriateness on each
Day shift following admission, and will be discontinued when the patient no
longer meets the charge criteria listed above. The nurse assigned to the patient
communicates with the HUC/PCT when the Level 5 – Adult Tracheostomy charge
should be discontinued. To discontinue the Level 5 charge will require changing
the accommodation code to General Care.
2. It is the responsibility of each NM to specify which staff member is accountable
for charge entry when a HUC/PCT is not working. Generally, the task of assuring
correct charges are reflected in the system will be assigned to either the CTL or
the nurse caring for the patient when a HUC/PCT is not available. The assigned
staff member is responsible for entering the Level 5 accommodation code into the
EMR.
C. Daily Patient Care Charge Review:
1. On a daily basis, the NM or Manager’s delegate (e.g. CTL/Senior Team Member
(STM) or HUC/PCT) 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
2. On a daily basis, the Manager or Manager’s delegate (e.g. CTL/STM or
HUC/PCT) must review the Revenue and Usage Report which lists all charges
posted for a patient the previous midnight. A comparison of the Revenue and
Usage Report 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 the EMR by the unit staff. If the patient has been discharged by the time

POLICY & PROCEDURE





Effective Date:
November 17, 2015

Administrative Manual
 Nursing Manual
 Other _______________

Policy #:
9.09

Original
Revision

Page 3
Of 3

Title: Criteria for Inpatient Daily Care Level
5 Charge – Adult Inpatient Tracheostomy
Patients



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. AUTHORED BY
A. Becky Moore, Financial Officer for Nursing & Patient Care Services


V. REVIEWED BY
A. Amy Armstrong, Manager, Charge Capture, November 2015
B. Nurse Manager, D65-Acute Medical Progressive Care Unit and F44-Surgical Trauma
Unit, November 2015
C. Fran Schultz, Nursing Informatics, November 2015
D. Nursing Administrative Policy & Procedure Committee, November 2015


SIGNED BY:

Beth Houlahan, DNP, RN, CENP
Senior Vice President Patient Care Services,
Chief Nursing Officer