Subdural Hematoma

ddraizeddraize
edited May 2016 in CDI Talk Archive
Hi I have a question that is more case management related than CDI but I would value any thoughts, a patient came to our facility through the ER and was diagnosis with subdural hematoma. She was having seizures, received IV ativan , morphine and vit k and plasma. Family did not want further intervention. Case management said that the patient would not meet inpatient criteria. Thought

Diane Draize RN, CPHM,CCDS
Clinical Documentation Specialist

Ministry Door County Medical Center
diane.draize@ministryhealth.org
920-743-5566 ex 3143

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Comments

  • Unknown
    edited May 2016
    If they have a physician advisor such as EHR they should run the case to one of them. Having done UR for almost seven years patient definitely meets inpatient. Many IV drugs and seizures-yes inpatient. Get the documentation from the physician advisor if you have one.

    Mary L. Snook RN-BC
    Clinical Documentation Specialist
    Medical Information Services
  • kmckaigkmckaig
    edited May 2016
    I totally agree from CM standpoint that if patient is not passing UR criteria screening with Interqual or Milliman, send to physician advisor. The inpatient criteria is a screen and as long as the documentation is complete and the physician documents his thinking, I would think at the very least, the case could be appealed.




    Karen McKaig, BSN, RN, CCM, CPUR, CCDS
    Case Manager
    Clinical Documentation Specialist
    Baxter Regional Medical Center
    Mountain Home, AR 72653
    870-508-1499
    kmckaig@baxterregional.org
  • annnd2009@gmail.comannnd2009@gmail.com
    edited May 2016
    I almost shouldn't respond I know so little about UR BUT(when will I learn)...I recently was at a observation presentation(4 hours) and a new ruling stated the new cms rules over ride anything including milliman...I found it... It's in the 8/15/13 ruling,my slide says, cms medical officer for payment policy,8/15/13 ODF

    ILL try to email a picture with words.
  • kmckaigkmckaig
    edited May 2016
    That is also the general consensus I am hearing as well. I think it all
    comes down to what the physician documents....in terms of not only
    clinical picture but anticipated length of stay as well. If the
    physician feels the stay is going to be less than 48 hrs then the acuity
    doesn't really matter to CMS. It's all about supporting documentation.
    Again the criteria is merely a screening tool but the physician
    documentation is what will support the need for admission with the 2-MN
    rule.



    Karen McKaig, BSN, RN, CCM, CPUR, CCDS
    Case Manager
    Clinical Documentation Specialist
    Baxter Regional Medical Center
    Mountain Home, AR 72653
    870-508-1499
    kmckaig@baxterregional.org
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