Observation to Inpatient

ddouthitddouthit
in CDI Talk Archive
We have seen an increase in observations converted to inpatient, unfortunately when the patient is being converted to inpatient there is not an "admitting" diagnosis associated with the conversion. Are any of you experiencing this? Are you querying for reason for admit? If so, can you share a query sample?
Thinking this is an issue for utilization review but would like feedback.
Thanks,

Dorie Douthit
ddouthit@stmarysathens.org

Comments

  • kshumpertkshumpert
    edited April 2016
    Hi Dorie,
    We have similar issues here. I am not quering for the reason for admit. The reason I do not query for this is because I am expecting UR/CM to have a discussion with the provider. I provide one on one physician education when the physicians are brought on staff and at recredentialing. When I provide the education, I candidly explain that short stays are a weakness. I explain that the cases that are lost are due to insufficient documentation. I review the Medicare's Benefits Manual to show the physicians that the onus lies with them, UR/CM are support for them to screen for appropriate status (as outlined in the CoP). I am also auditing the UR/CM notes daily. I do this because in our RAC audits, we found that the case management notes were a hindrance rather than an added asset to the physician documentation. I have created a template for case management to use to document their screening process. In my role, I work in tandem with UR/CM to support medical necessity documentation, however, I report to HIM.

    Thanks,
    Kathy
    Kathy Shumpert, RN, CCDS

    Clinical Documentation Improvement Specialist
    Community Howard Regional Health
    3500 S Lafountain
    PO Box 9011
    Kokomo, IN 46902
    Office 765-864-8754
    Cell 765-431-0123
    Fax 765-453-8447
  • michelleclynemichelleclyne
    edited April 2016
    Our utilization review staff write the reason for inpatient conversion.

    Michelle Clyne, R.N. MSN/MHA
    Clinical Documentation Improvement
    Conifer Health Solutions
    Good Samaritan Hospital
    10 E. 31st Street
    Kearney, NE 68847
    Office: 308-865-7951
    michelleclyne@catholichealth.net
  • Unknown
    edited April 2016
    The reason the patient is admitted into inpt status is the pdx! What bought the bed?

    Jamie Dugan RN CCDS
    Baptist Health System
    Jacksonville, FL
  • evanspx@sutterhealth.orgevanspx@sutterhealth.org
    edited April 2016
    OBS rules state the reason for the status change from OBS to INPT is the PDX....in this case, it would be ARF.

    Paul Evans, RHIA, CCS, CCS-P, CCDS

    Manager, Regional Clinical Documentation & Coding Integrity
    Sutter West Bay
    633 Folsom St., 7th Floor, Office 7-044
    San Francisco, CA 94107
    Cell: 415.412.9421

    evanspx@sutterhealth.org
  • katysuegood@gmail.comkatysuegood@gmail.com
    edited April 2016
    Thanks everyone! That's what I thought but when no one else seems concerned about this issue I start thinking maybe I'm crazy!!!

    Thanks again!

    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
  • katysuegood@gmail.comkatysuegood@gmail.com
    edited April 2016
    One more thing...
    From the documentation standpoint, do you query when it is unclear why the patient was moved to IP status? Am I the only one working in a facility where it is often unclear why the patient was made IP and the physicians never indicate why the switch was made?

    Thanks!

    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
  • evanspx@sutterhealth.orgevanspx@sutterhealth.org
    edited April 2016
    I can generally find the reason per the Admit Order when the status changes from OBS to Acute.

    Paul Evans, RHIA, CCS, CCS-P, CCDS

    Manager, Regional Clinical Documentation & Coding Integrity
    Sutter West Bay
    633 Folsom St., 7th Floor, Office 7-044
    San Francisco, CA 94107
    Cell: 415.412.9421

    evanspx@sutterhealth.org
  • katysuegood@gmail.comkatysuegood@gmail.com
    edited April 2016
    Yeah. Ours don't have any information in them. Just an order for inpatient admission :(

    I am wondering if we need to develop a query specifically for this purpose??

    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
  • kshumpertkshumpert
    edited April 2016
    Hi Katy,
    We do query for clarification as to the reason for admissions some times. We have have a field within our inpatient order, but sometimes early on it may just be a symptom or a difference in what the ER documented in the order versus the documentation by the attending in the H&P.
  • katysuegood@gmail.comkatysuegood@gmail.com
    edited April 2016
    When they admit to IP from the ED, we generally don’t have a problem. But when they admit to OBS fromt eh ED and then a day or two later they meet IP criteria and switch to IP it gets really dicey. All the coder sees is an H&P written on the day they were made OP. It is all filed under the same encounter so I don’t think they even ever realize that the patient was in OBS for two days in house.
    You can see how this is a problem. Not only can we possibly end up with the wrong PDX/DRG, what about our POA status’s!!??! They are then noting anything that occurred after admission to OBS as POA(N) when really as long as it occurred prior to IP admission, it should be POA(Y).

    I am probably in the middle of making a mountain out of a mole hill…

    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
  • ssalinasssalinas
    edited April 2016
    You are correct Katy. Here is the POA Guideline regarding that situation.

    Condition develops during outpatient encounter prior to inpatient admission

    Assign Y for any condition that develops during an outpatient encounter prior to a written order for inpatient admission.

    Sharon Salinas, CCS
    Barlow Respiratory Hospital
    2000 Stadium Way, Los Angeles CA 90026
    Tel: 213-250-4200 ext 3336
    ssalinas@barlow2000.org
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