Monday, June 15, 2015

Manure

In another doc's hospital note:


Honestly, if you're typing such horseshit as a standard part of every note, you're full of crap. Especially since I've been watching you round on this floor for the past hour. You're by yourself. And most of the time you're only putting 1 foot in a patient's room, anyway.

How much extra are you charging the insurance for writing that (or, more likely, cut & paste) in your note?

17 comments:

Anonymous said...

Does Medicare or Medicaid offer anonymous rewards for people turning in fraud?

Anonymous said...

Ahh, the old one-footed FTD exam (from the door.)

Kassy said...

Well, I assume you know inpatient documentation coding. So by noting that he spoke with someone other than the patient he gets 1 point in the data field under management. If he doesn't document the contents of that conversation than that is all he gets.
Since changing from a level 2 note to a level 3 note requires 4 data points from 3 it is unlikely to be the difference.
For example, I reviewed radiology study report(1 point), labs(1 point) and spoke to the million people listed above(1 point) for total of 3 points. That is only going to get level 2 inpatient f/u note. So didn't help him at all.
Now if he actually looked at the x-ray and recorded his own impression(2 points), reviewed labs( 1point) and talked to the million people(1 point) than that is 4 points and is good enough for a level 3 visit assuming he also has at least 4 points of medical problems(in an inpatient setting in f/u that requires 4 indiviudal problems, or 2 problems getting worse or 1 new problem and 1 old problem) OR has the patient on IV controlled substances or similarly high level medical management.
Than in addition to that he needed either a detailed HPI OR a detailed physical exam.
All this to say, it probably didn't help him at all when someone reviews the notes.
Also, all of this to say, documentation requirements and coding levels have nothing to do with how sick or complicated the care of the patient is. It's all about what you can document and if luckily they have an x-ray or EKG to look at. *sarcasm off*

Anonymous said...

"...and we're achieving synergies by leveraging our core competencies..."

Packer said...

The med student hangs on your every word.

Hildy said...

To anonymous at 4:22am: No financial reward, but a surprising and rewarding amount of gratitude. (I let them know that an equipment rental company was continuing to bill medicare for a wheelchair I had returned months before.)

And to Kassy: If that's what you have to know to do inpatient coding, my hat is off to you! I could barely follow it.

Anonymous said...

@ anonymous 4:22 AM, look into the False Claims Act. Possible big financial reward vs a lot of trouble. Hildy's method is almost certainly better for small stuff.

Anonymous said...

"What can I say; my foot is one of many talents..."

Anonymous said...

Just to be the devil's sdvocate, the note says nothing about them being there at the same time. No one ever makes rounds like that, though they may look at notes others wrote when they rounded, or sit down with them every now and then at a patient care discussion. As to examining the patient, that is definately wrong to document, though I suppose one can argue that you can observe the status of the patient from the end of the bed, and evaluate the data in the chart. Sort of like when you observe how a patient converses and how they get out the chair when they leave and put that in your neurologic evaluation.

Anonymous said...

Worked as a tech at a hospital, and this story reminds me of the doctor who had the most unusual (and rude) rounding behavior. It was almost as if he would wait until the patient was up, ambulating to the bathroom when he'd step in and do his 5-second assessment over the threshold of the doorway. I guess he figured if he caught them in this state, he could spend maybe 2 minutes on the patient before moving on. No wonder people hate doctors...fortunately they're not all like this.

Struck by a Turtle said...

He's covering his bases for billing split/shared.

Scrub Ninja said...

I think it's ass-covering because he is not spending a lot of time in the room. If he said "I examined this patient," he would be saying that he did his own full assessment and 12-point review. But by saying that he examined them "with the team," he can just base his work on everyone else's assessments.

Kassy said...

That is the cliff notes.the actual rules are about 35 pages long

Anonymous said...

A few years ago, my elderly mother spent a few weeks in the hospital. One Saturday morning, (her regular Doctor was off for the day) another Dr. came in, holding a cup of coffee from Starbucks, looked at my mom's chart and asked her how she was doing. My mom said O.K. the Dr. nodded and as she started to leave, my mom muttered...'That's a hundred dollars added to my bill." my husband and I started to laugh because the Dr. heard what she said.

Angry Psychiatrist said...

Lololololol. The "cranial nerves 2-12 WNL." Does that still work?

Angry Psychiatrist said...

Lol. That is preferable to being poked and prodded and undressed unnecessarily in order to get that hundred bucks. Trust me. If government cracks down and says we have to poke and prod you and stick a finger in every orifice to get that hundred bucks then undress and bend over cuz here it comes.

Anonymous said...

And if he actually brought them his patients' outcome would likely have been better with no added effort on his part. And with the coder to keep him honest

 
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