Is it true that in ICD-10 the Surgeon is captain of the ship?

cmorellcmorell
in CDI Talk Archive
Some new CDIs went to a consultant led CDI presentation that included ICD-10 information. They understood the speaker to say in ICD-10 the Surgeon is captain of the ship? Obviously only for cases with a surgeon...has anyone else heard this?
If not, any idea what the speaker might have said that they misunderstood?

Thanks!
Charrington "Charlie" Morell

Comments

  • evanspx@sutterhealth.orgevanspx@sutterhealth.org
    edited May 2016
    My interpretation of the various stated rules and guidelines is that the "Attending" makes the final decision regarding any areas of clinical dissonance with a chart - however, if the question is purely surgical in nature (did you excise tissue surgically and was the tissue excised fascia or muscle), the query should be directed to the Surgeon performing the procedure.

    At our facility with multiple physician teams, the Surgeon may or may not be the attending - actually, one patient may have one MD as attending for a few days, and then may be passed to a 2nd or even 3rd Attending. All of this complexity makes physician attribution an issue and a problem.



    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:  415.637.9002
    Fax:  415.600.1325
    Ofc:  415.600.3739
    evanspx@sutterhealth.org
  • katysuegood@gmail.comkatysuegood@gmail.com
    edited May 2016
    You guys may have seen my comments about attribution in the latest CDI journal. We have struggled with this a lot at our facility. I think (assume) that attribution used to be something only HIM was concerned with but with all the new quality standards/measures, attribution has become something our physicians are suddenly very interested in as well. We have many employed physicians at our facility (hospitalists and intensivists) and patients often have multiple 'attending' MD's during their stay as they rotate through. We now have a rather complex attribution policy that HIM follows. It does sequence the surgeon as the attending MD (except in cases of a trach/PEG) for retrospective purposes (coding).
    It's definitely not perfect and in no way does it make everyone happy or 'make sense' in every case. But, it is the best we could come up with given the complex environment.

    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
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