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    GCS Assessment Aid Bahasa

    Uploaded by

    Merry Andriany
    Gcs

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    © All Rights Reserved
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    GCS Assessment Aid Bahasa

    Uploaded by

    Merry Andriany
    324 views9 pages
    Gcs

    Original Title

    GCS Assessment Aid Bahasa (1)

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    Gcs

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    324 views9 pages

    GCS Assessment Aid Bahasa

    Uploaded by

    Merry Andriany
    Gcs

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
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    Coma Definition

    Spectrum of Altered Level of Consciousness & Responsiveness


    – Severe: Coma
    – Moderate: Obtundation / stupor
    – Mild: Lethargy / somnolence

    Clinical circumstances
    – Trauma
    – CVA / brain hemorrhage
    – End-stage dementia / degenerative brain diseases
    – Severe metabolic/physiologic disturbances (e.g., anoxia, hypothermia,
    diabetes, severe electrolyte imbalance, many others)
    – Organ failure (e.g. hepatic or uremic coma)
    – Encephalitis/meningitis
    – Medications, drugs and toxins

    © 2016 HCQ Consulting


    Glasgow Coma Scale (GCS)

    Objective measure of consciousness and responsiveness


    Prognostic significance in trauma only
    Valid objective measure in all circumstances
    Total score 3 to 15
    – Eye opening: 1 to 4
    – Verbal response: 1 to 5
    – Motor response: 1 to 6
    Diagnostic correlation:
    – Total score 3-8: Coma
    – Total score 9-12: Obtundation/stupor
    – Total score 13-14: Lethargy / somnolence

    © 2016 HCQ Consulting


    Glasgow Coma Scale (GCS)

    Spontaneous 4
    Eye Verbal Command 3
    Opening To pain 2 MCC
    None 1 MCC
    Oriented 5
    Confused but answers questions 4
    Verbal Inappropriate, words discernible 3
    Incomprehensible speech 2 MCC
    None 1 MCC
    Obeys commands 6
    Purposeful movement to pain 5
    Withdraws (reflexive) from pain 4
    Motor
    Abnormal (spastic) flexion 3
    Extensor (rigid) response 2 MCC
    None 1 MCC

    © 2016 HCQ Consulting


    Coding Guidelines

    Documentation
    – Coma
    – Unconsciousness
    – Persistent vegetative state
    GCS
    Excludes 1 Note
    Official Coding Guidelines

    © 2016 HCQ Consulting


    Coding Guidelines

    Coma (MCC) requires diagnosis by provider


    – Unconsciousness coded as coma
    • Must be prolonged
    • Not transient like seizure or concussion
    – Persistent vegetative state coded as a CC: query for coma

    GCS
    – No requirement for documentation of “coma”
    • But need something that makes the GCS pertinent (e.g., altered mental status)
    – Code from scoring sheet by any healthcare professional
    • Examples: nurse, pre-hospital EMS
    – Use lowest score obtained
    – Do not code total score if components coded
    – Lowest 2 scores of each component are MCCs

    © 2016 HCQ Consulting


    Coding Guidelines

    Excludes 1 note for R40-R46 which includes coma and GCS when
    they are part of a pattern of a mental disorder (F01-F99).
    • Psych conditions, dementia, intellectual disability, as well as
    alcohol and drug use, abuse, dependence, intoxication, etc.
    • Not excluded in these conditions when due to something else
    • Not excluded from poisoning, adverse effect or toxic effect
    • Not excluded from conditions other than F01-F99 such as
    severe metabolic and physiologic disturbances or infections like
    encephalitis/meningitis

    © 2016 HCQ Consulting


    Official Coding Guidelines

    Section I.C.18.e: “The coma scale codes (R40.2-) can be used in


    conjunction with traumatic brain injury codes, acute
    cerebrovascular disease or sequelae of cerebrovascular disease
    codes. These codes are primarily for use by trauma registries, but
    they may be used in any setting where this information is
    collected. The coma scale codes should be sequenced after the
    diagnosis code(s)”
    Does not prohibit use in other situations such as:
    – Drug overdose
    – Severe electrolyte imbalance
    – Encephalitis
    Remember Excludes 1 note for mental disorders

    © 2016 HCQ Consulting


    Hepatic Encephalopathy

    ICD-10 assigns to hepatic failure with or without coma


    5 pairs of codes:
    – NOS
    – Alcoholic
    – Due to drugs
    – Acute/subacute
    – Chronic
    With coma is MCC
    – Appears to require a diagnosis of coma or unconsciousness?
    – Other significant manifestations seem to be excluded from “with coma”?
    • Agitation, disorientation, confusion, asterixis

    ICD-10 changes to include hepatic encephalopathy without coma


    are being considered

    © 2016 HCQ Consulting


    Physician Education

    Encourage awareness
    Stress importance of GCS
    Establish organizational process for recording GCS in
    record of all patients with altered level of consciousness
    ACDIS commercial educational tool:
    CDI for the Clinician™

    © 2016 HCQ Consulting

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