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Title: Section 86-1.42 - Potentially preventable negative outcomes

Effective Date


86-1.42 Potentially preventable negative outcomes.

(a) Effective for discharges occurring on or after July 1, 2011, payments pursuant to this Subpart shall be denied with regard to the following potentially preventable negative outcomes if they are acquired during a patient's inpatient stay at the hospital seeking such payments:

(1) A foreign object retained within a patient's body after surgery.

(2) The development of an air embolism within a patient's body.

(3) A patient blood transfusion with incompatible blood.

(4) A patient's development of stage III or stage IV pressure ulcers.

(5) Patient injuries resulting from accidental falls and other trauma, including, but not limited to:

i. Fractures

ii. Dislocations

iii. Intracranial injuries

iv. Crushing injuries

v. Burns

vi. Electric shock

(6) A patient's manifestations of poor glycemic control, including, but not limited to:

i. Diabetic ketoacidosis

ii. Nonketotic hyperosmolar coma

iii. Hypoglycemic coma

iv. Secondary diabetes with ketoacidosis

v. Secondary diabetes with hyperosmolarity

(7) A patient's development of a catheter-associated urinary tract infection.

(8) A patient's development of a vascular catheter-associated infection.

(9) A patient's development of a surgical site infection following:

i. a coronary artery bypass graft – mediastinitis;

ii. bariatric surgery, including, but not limited to, laparoscopic gastric bypass, gastroenterostomy, and laparoscopic gastric restrictive surgery; or

iii. orthopedic procedures, including, but not limited to, such procedures performed on the spine, neck, shoulder and elbow.

10. A patient's development of deep vein thrombosis or a pulmonary embolism in connection with a total knee replacement or a hip replacement, excluding pediatric patients, defined as patients under eighteen years of age, and also excluding obstetric patients, defined as patients with at least one primary or secondary diagnosis code that includes an indication of pregnancy.


VOLUME A-2 (Title 10)