Per IPFQR Specifications,
"For the TR-1 measure, each discharge from the IPF must be abstracted as a separate episode of care, not based on how the inpatient stay was billed. This applies regardless of whether the patient was discharged from the IPF to home, to another unit within the same facility, or to a different inpatient facility. If a patient is transferred from an IPF unit to another IPF unit within the same healthcare system and the IPF units share the same CCN, this should be abstracted as one episode of care."
In order to address this, a TR discharge grid (TR Multiple Records Per Visit) for additional TR discharges has been added to the abstraction page.
Two new fields have been added to the TR worksheet. TR Admission Date and TR Discharge Date. These will be the dates you edit for each TR Discharge. If there is only one TR Discharge, the TR Admission Date and TR Discharge Date should not be changed, but should match the Overall Admission Date and Discharge Date.
The Overall Admission Date and Discharge Date will match the SMD, HBIPS-Global and HBIPS-DSC cases. Do not change these UNLESS the billed visit is incorrect.
The TR case in the top abstraction grid (where the SMD, HBIPS-Global and HBIPS-DSC abstractions are found), should always be abstracted for the FINAL TR discharge if there are multiple discharges.
There are two possible scenarios - the TR case exists in the main abstraction grid or it does not. TIPS are provided at the end of the article.
Part 1: Adding a TR Discharge Record for a Case Already in the Main Abstraction Grid
Abstract the main TR case. Correct the TR admission date, since the FINAL discharge from the IPF should be abstracted here. For our example case, we will use a billed Admission Date of 1/10/2023 and a billed Discharge Date of 1/20/2023 (Overall Admission and Discharge Dates). The patient left the IPF to another unit on 1/16/2023 and returned 1/17/2023 to stay until final Discharge of 1/20/2023. We will need the main abstraction worksheet to reflect 1/17/2023 TR Admission Date to 1/20/2023 TR Discharge Date.
These dates (Overall Admission and Overall Discharge) should not be changed unless they are incorrect for the total billed visit.
Change the TR Admission Date to 1/17/2023 and leave the TR Discharge Date as 1/20/2023. Complete the Abstraction for the TR case from 1/20/2023 as you normally would.
Once the main abstraction is Abstraction Status, "Abstraction Completed", you will be able to navigate to the lower TR grid and see the case.
Click the + in front of the case to expand and then click the edit icon to add a TR Discharge Record.
Enter the information for the TR Discharge, including the time period the Discharge Record is for, in the TR Admission Date and TR Discharge Date. The Calendar icon will open a list of Transition Records already present on the case. With our example case, we need an additional Transition Record for the Admission Date to the first Discharge Date of 1/16/2023. The TR Admission Date will be 1/10/2023 and the TR Discharge Date will be 1/16/2023. Once the dates are saved, abstract the case as usual for the 1/16/2023 discharge from the IPF.
Click Save or Save and Exit.
The new record will now be in the TR Discharge Grid.
Part 2: Adding a TR Discharge Record for a Case not in the Main Abstraction Grid (not selected for sample or not final discharged)
- In the TR Multiple Records per Visit Grid, click the Add TR Record icon.
- This will open a blank worksheet, where demographic data will need to be manually entered.
- Once the Patient Identifier and Case Identifier are entered, click Save Patient/Case ID. This will ensure that any additional Transition Records that are added will be checked for overlap and display error messages.
- Continue adding the demographic data and abstract the TR portion as usual (from #5 in Part 1). Once you Save and Exit, you will see the case in the TR Multiple Records per Visit Grid.
1. Identify which Transition Record you are in by the TR Key on the Floating Toolbar. The TR Key is a number assigned to each additional record for a particular billed visit. The main TR case will not have a TR Key displayed.
2. Diagnosis and Procedure Codes for each Transition Record should reflect the Diagnoses and Procedures for that part of the billed visit.
3. Changing Sex, Name, Source of Payment and other demographic data elements will NOT carry over to the other TR cases for the billed visit. They must be changed in all manually.
4. An import to update the Overall billed visit will NOT carry over to the additional TR cases. They must be deleted and re-added OR the data elements changed can be manually updated if the field on the worksheet is editable.
One more example to illustrate how TR admit and TR discharge dates should be determined.
Imaginary Visit was 7/1/2022 - 7/30/2022 combined and billed under IPF.
7/1-7/5 In IPF
7/5 - 7/8/2022 Transfered to Surgery and recovery on surgical floor
7/8-7/10 Back in IPF
7/10 - 7/14 To medical floor for a surgical complication
7/14-7/30 Back in IPF
Per CMS IPFQR Q & A tool:
The admission date is based on when the patient begins to receive care in the IPF unit and discharge date is indicated by when that care stops, as indicated by the data elements on pages 16 and 33, respectively, in the IPF Specifications Manual, v1.0b (https://qualitynet.cms.gov/ipf/specifications-manuals#tab3). Per the information provided, the admission and discharge dates below are accurate:
7/1 - 7/5 TR first discharge
7/8 - 7/10 TR second discharge
7/14 - 7/30 TR third discharge