inpatient surgery only

Unknown

Wondering if anyone out there has a formal process for checking their elective inpatient surgeries for correct admission status. We just received denials from the RAC on laminectomies as an inpatient surgery. We were obviously counting on the physician's office to know the correct status.

Thank you,

Chris Lamboley, RN, BSN
Utilization Review Supervisor

Illinois Valley Community Hospital
925 West Street
Peru, IL. 61354
O: 815.780.3294
F: 815.780.3640
Chris.lamboley@ivch.org

Unknown

Wow that's all I can say? As the CDI team we are not yet involved in
correct admission status. Our Manager does have us check all admissions
for the impatient admission order however.

Thanks,


Jamie Dugan RN
Baptist Health System
Jacksonville, Florida
Office 904-202-4345
Cellular- 904-237-7253

dvitalone1

As of right now our UR/CM team is responsible for that.


Dawn

megan.barton

Chris,

Our UR department checks the status even when the patient is scheduled by the physician. I believe that most laminectomies are IP per InterQual (this is standard my hospital uses).

Megan

Megan Barton RN, BSN
Manager Clinical Documentation Improvement
Health Information Management-Mercy East
Ph: 314-251-6192

sharon.cole

We have a Case Manager assigned to OPS and Cath Lab who reviews these for correct status order. If order incorrect she contacts physician for correct order.

Sharon Cole, RN, CCDS
Providence Health Center
Case Management Dept
254.751.4256
Sharon.cole@phn-waco.org

arobinso

Yes, But I am not only the CDI person, but CM falls under me too. I have a case manager review the schedule each day prior. If incorrect the case manager calls the surgeon and ask for the correct order. We have also educated the Pre-Cert staff regarding "inpatient only" cases.

Mandi Robinson, RN, BS,CPC
Administrative Manager
Financial Services
CDI/Case Management
Trover Health System
270-326-4982
arobinso@trover.org
"Excellent Care, Every Time"

Unknown

Megan,

Thanks. I see where you get that from IQ but the RAC denial stated the surgery is not on the MEDICARE Inpatient List Only. IQ also states that little tid bit about their list does not necessarily align with CMS guidelines. Just be careful. The surgeries were from 2009-2011.

Chris

Unknown

Yes, we thought we had it under control but apparently not...back to the round table with this one.

gwojo

Chris, information that may help you.

Francisca Wojciechowski BS, RHIA, RHIT, CCDS

AHIMA-Approved ICD-10-CM/PCS Trainer


http://www.ehrdocs.com/pdf/news/RMC_Hospitals.pdf 

kshumpert

Chris,
Our Case Management department has provided our surgical department a copy of the inpatient only list-limited to the surgical cases that we perform. Additionally our UR staff screen utilizing Interqual criteria.

As part of the RAC team, I write the appeals for the denials and use Interqual criteria for my appeals. Were the lamies short stays-as in 1 day? We have had issues with procedures that were short stays. Additionally it is hard to get documentation from the surgeons because they receive a global payment and do not have to provide a detailed progress note for payment. Involve these surgeons in any appeals process so that they may learn.

Kathy Shumpert
Community Howard Regional Health

katysuegood@gmail.com

Ours too.

Katy Good, RN, BSN, CCDS, CCS
Clinical Documentation Program Coordinator
AHIMA Approved ICD-10CM/PCS Trainer
Flagstaff Medical Center
Kathryn.Good@nahealth.com
Cell: 928.814.9404

sharon.cooper@owensborohealth.org

We have the same process as mentioned by Sharon Cole.


Sharon Cooper, RN-BC, CCS, CCDS, CDIP
AHIMA-Approved ICD-10-CM/PCS Trainer

Owensboro Medical Health System
Manager Clinical Documentation & Appeals
P.O. Box 20007
Owensboro, KY 42304-0007
(270) 688-1277 Office
(270) 316-9088 Cell
(270) 688-2737 Fax
sharon.cooper@omhs.org

TEAM = Together Everyone Accomplishes More!

gwojo

Your welcome. Also, look for one-day stays (all one-day stays will be audited) , co-morbids; reasons the physician would admit the patient for sugery. Good luck.



Francisca Wojciechowski BS, RHIA, RHIT, CCDS

AHIMA-Approved ICD-10-CM/PCS Trainer

sbaine

Chris et al,

We do have Case Managers as well. Speaking as a past Case Manager I can tell you how frustrating it is to get the IP only orders correct. We have a dedicated process- CMs review MCR surgical case list each day. ALL MCR surgeries are checked for MCR IP only surgeries on the list. Those are sent to the coders for DRG assignment verification. Then checked against the list for IP only surgeries.

Common cases such as CABGs & Fusions are a no brainer for us but the issue usually is the abdominal cases and Neurosurgery. We keep that list in a computer file for reference if denied.

Then the list is faxed to Preop for the nurses to verify that the orders for surgery contain IP orders for the necessary charts. The patient IS NOT sent to the OR suite if the order is NOT obtained. We have had a few delays then it was not a issue further. We have to fax the list no later than 4pm each day. On Fridays we look at Monday surgeries as well and include that in the list faxed to Preop.

Hope this helps.

Sara Baine,MSN-Ed CCDS
CDS, Chairperson, CDMP Taskforce
SoutheastHEALTH
Cape Girardeau, Mo.
www.sbaine@sehealth.org

acarducc@montefiore.org

we have a proces in which we review all elective procedure cases against the CMS Inpatient Only list. If a procedure is not on the Inpatient only list, we refer the case to a physician to review regarding outpatient or inpatient status.



Ann-Marie Carducci, RN, MPA, CPHM, CPHQ, CPC, CCS, CCDS

Director, Utilization Management

Montefiore Medical Center

914-377-4678 - Yonkers Office

718-904-2695 Einstein Office

917-574-6781 - Cell

email: acarducc@montefiore.org