With the upgrade to Cypress v2.4 the pneumonia (CMS 188) patients have changed to be in a non-ICU location when previously they were in an ICU location. My first question is: what was the rationale for that?

Secondly, we see that this patient has a non-ICU encounter based on the HS-LOC code and they also don’t have presumptive pneumonia so that’s why they are expected to be in PN6b (non-ICU), rather than PN6a (ICU). However, there is also a SNOMED code on the patient for an “ICU admission or transfer” which is from a valueset which only applies to VTE-2. Is the patient intentionally receiving ”ICU admission or transfer” within a non-ICU location, or should they also have a corresponding ICU stay which is recognizable by PN6? For this document to be correct for both VTE and PN, I believe that the patient should also have an Encounter, Performed: Encounter Inpatient with a facility attribute specifying an ICU location.

The larger issue is that the way VTE-2 and PN-6 logic determines whether or not a patient is an ICU patient is different. VTE-2 looks for an ICU admission/transfer while PN-6 looks to see whether the location is an ICU location or not. This difference in ICU determination creates the potential for a patient to be considered in an ICU (for VTE-2) AND not in an ICU (for PN-6) at the same time (like the Cypress patient mentioned above).