1 Day Chest Pain

Unknown
in CDI Talk Archive
Would like some feedback from everyone on how your facility handles one day inpatient chest pain? We see alot of documentation of CP due to gastric etiology but when the physician is queried for a more specific gastric diagnosis..they will not provide one because the GI workup is to be done as an outpatient. Thanks in advance for your feedback.

Comments

  • robert.hodges2robert.hodges2
    edited May 2016
    In my case management days we would put anything like this into outpatient observation unless the admitting provider gave us enough to justify the InterQual for an inpatient stay. We also made it clear that they may have to back up their decision to make them an inpatient to the insurance company if it came to an appeal. Lots of provider education and case management in the ER helped with this.

    Now on the CDI side, I still have that challenge for a more specific diagnosis, but remember you can ask them what they suspect or are ruling out. They may be willing to document that. Remind them that Medicine, like nursing, is art and science and their professional opinion means a lot.

    Robert

    Robert S. Hodges, BSN, MSN, RN
    Clinical Documentation Improvement Specialist
    Aleda E. Lutz VAMC
    Mail Code 136
    1500 Weiss Street
    Saginaw MI 48602
     
    P: 989-497-2500 x13101
    F: 989-321-4912
    E: Robert.Hodges2@va.gov
     
    "Anyone who has never made a mistake has never tried anything new." -Albert Einstein 


  • Unknown
    edited May 2016
    Robert that was well said! " Medicine, like nursing, is art and science and their professional opinion means a lot."
    I find that sometimes the docs forget that and focus only on "criteria".

    Gina Spatafore, RN
    Clinical Documentation Integrity Specialist
    Waterbury Hospital
    203 573 7647


  • soccerballsmartysoccerballsmarty
    I think you are missing the boat on the question. It seems that the question for more specificity is in a situation where more specificity is not available, as in the case with the patient continuing in the outpt. setting (EGD not done in-house) but the coding guidance recommends a query for more specificity, what then?
  • dallend@einstein.edudallend@einstein.edu
    edited May 2016

    I review cases on a cardiac floor and my background is cardiology.
    One day chest pains give me chest pain. Many of our cases are being downgraded by care management if they do not meet inpt criteria.
    That being said - the ones that do meet inpt criteria, amazingly, still are an issue.
    You can only query based on the information in the chart. Sometimes there is nothing to work with. It is possible sometimes to query for a probable diagnosis - maybe they start the pt on protonix while in house with chest pain resolving - EGD to be done as outpt.
    I find that if a blind query is left you usually get garbage back - x vs x vs x - and you are not better off than you were before.
    Sometimes it's just chest pain and that's all you have.


  • robert.hodges2robert.hodges2
    edited May 2016
    I routinely query for more specificity and even have a chest pain template query form that I use. I don't often get something, but on occasion I do. As I tell my providers, I'm looking for as accurate a diagnosis as I can get for continuity of care.

    Robert

    Robert S. Hodges, BSN, MSN, RN
    Clinical Documentation Improvement Specialist
    Aleda E. Lutz VAMC
    Mail Code 136
    1500 Weiss Street
    Saginaw MI 48602
     
    P: 989-497-2500 x13101
    F: 989-321-4912
    E: Robert.Hodges2@va.gov
     
    "Anyone who has never made a mistake has never tried anything new." -Albert Einstein 


  • judithbatesjudithbates
    edited May 2016
    We use a template for any patient admitted with chest pain. This serves as a reminder that hopefully on d/c they will be documenting the etiology of this symptom dx. Does anyone do retro queries on patients who still have a symptom dx on discharge???

    Judi Bates RN, BSN, CCDS
    CDI Specialist
    856-757-3161
    Beeper 66x2906

  • dallend@einstein.edudallend@einstein.edu
    edited May 2016

    We did try to put out a chest pain template but it was not approved. One of our problems was that we would query and get about 6 different possible causes or someone would document a possible cause and, before discharge, the attending would document atypical and unknown etiology. Fortunately, many of our cases are now being downgraded so it is not as big an issue as it one was.


  • dallend@einstein.edudallend@einstein.edu
    edited May 2016

    We do - if there is sufficient information in the chart to warrant a query.


  • twoodstwoods
    edited May 2016
    Our HIM coders will after DC.

    Theresa Woods, RN, MSN
    Jennings American Legion Hospital
    1634 Elton Road
    Jennings, La 70546
    Phone: 337-616-7297
    Fax: 337-616-7096
    twoods@jalh.com
    "Attitude is a little thing that makes a big difference." Winston Churchhill

  • pfowlerpfowler
    edited May 2016
    HIM Coder queries after d/c.



    Patsy Fowler RN, MSN, CCDS

    Certified Clinical Documentation Specialist

    Marion Regional Medical Center

    PO Box 1150

    Marion, SC 29571

    Office 843-431-2044

    Cell 843-431-2863

    Fax 843-431-2475




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