Physician Resource

cmorellcmorell
in CDI Talk Archive
Hello all ACDIS gurus. Some of my physicians are asking if there is some reference or book they can look at to explain documentation. I guess they want a more comprehensive tip card in the form of a book as well as all of the explanations of why it is important to them.

Any resources come to mind? We already have a portable slide show and things of that nature. I was hoping to find something written by a physician (they tend to give more credence to information written by their peers.)
Thanks,
Happy Queries!

Comments

  • twoodstwoods
    edited May 2016
    Are you willing to share your tip card?

    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

  • robert.hodges2robert.hodges2
    Have you checked the Forms and Tools Library on the ACDIS site? There are also some articles by Dr Gold that I've read that are very good. Maybe one of the white papers on the site.

    Just my thoughts.

    Robert

    Robert S. Hodges, BSN, MSN, RN
    Clinical Documentation Improvement Specialist
    Aleda E. Lutz VAMC
    Mail Code 136
    1500 Weiss Street
    Saginaw MI 48602
  • kshumpertkshumpert
    edited May 2016
    There is a booklet that Dr. Gold has authored called Documentation Strategies to Support Severity of Illness Ensure an Accurate Professional Profile. It has been my experience that physicians are much more receptive about learning about their ability to impact their profile and support their E/M billing.


    Kathy Shumpert, RN, BSN

    Clinical Documentation Improvement Specialist
    Howard Regional Health System
    Office 765-864-8754
    Pager 765-604-0424
    Fax 765-453-8152

    Proofread carefully to see if you any words out. ~Author Unknown



  • dsmith12h@aol.comdsmith12h@aol.com
    edited May 2016
    There is a small (7'"x4") spiral bound book available called Inpatient (IPPS) Doumentation Tips for Physicians. It is written by Dr. Bibbins, MD and can be found @ http://www.docucompllc.com/docued/, http://www.docucompllc.com/docued/book.php.

  • dsmith12h@aol.comdsmith12h@aol.com
    edited May 2016
    Also, there is an old publication (2009) @ http://www.afmc.org/HTML/index/index.aspx orr try http://www.afmc.org/Documents/cme/hpmp/PDIPPSMANUAL042008.pdf. Good information, but old. There were physicians on the editorial panel for this.

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

    I purchased this - there are several typos in this book. Perhaps they are corrected now.

  • cmorellcmorell
    edited May 2016

    I am so grateful to have all you stellar colleagues to mentor me! I will be happy to post my tip cards as soon as I finish them, I am remaking them, I had made them very comprehensive, but now they are not conveniently pocket sized. I shall make them smaller and to go on a ring (still keeping the comprehensive feature). As soon as they are ready, I will gladly post them for all of you! Actually, I will attach the longer one for you to use as you wish now.

    You are all the very best!
    Thank you!

    Charrington Morell, RN, CCDS
    HCA Healthcare
    Regional Medical Center Bayonet Point
    Hudson, FL
    (727) 819-2929 X 2252
  • vleadbetter@cmcvtx.orgvleadbetter@cmcvtx.org
    edited May 2016
    Kathy,
    This sounds exactly like what I have been looking for. I tried to find it online, but it seems to be out of print. Do you know if there is anything else out there like this?

    Thanks,
    Vickie Leadbetter, BSHIM, RHIT
    Citizens Medical Center
    361-572-5103

  • kari.eskenskari.eskens
    edited May 2016
    http://www.hcmarketplace.com/prod-3789/Documentation-Strategies-to-Support-Severity-of-Illness.html

    See above link. I picked up this book several years ago at the AHIMA Annual Convention. It is a good resource.


    Kari L. Eskens, RHIA
    BryanLGH Medical Center
    Coding & Clinical Documentation Manager


  • kshumpertkshumpert
    Dr. Kennedy authored a book as well; Severity DRGs and Reimbursement An MS-DRG Primer. If you can't get it, look at the power points from the conference. There is one regarding case studies, death review and severity of illness. You could run a report or pull a few charts from expired patients (by physician) and review what was coded, SOI, and ROM. If the SOI and ROM are not 4/4, try to find what is missing that would have brought it up. I have physicians that request for me to run reports for them because they want to know how they are doing. It is easier to look back retrospectively sometimes and my perception has been that our physicians weren't so testy with the review like they can sometimes be with queries.


    Kathy Shumpert, RN, BSN

    Clinical Documentation Improvement Specialist
    Howard Regional Health System
    Office 765-864-8754
    Pager 765-604-0424
    Fax 765-453-8152

    Proofread carefully to see if you any words out.
  • dsmith12h@aol.comdsmith12h@aol.com
    edited May 2016
    Here is another. Sold in bulk (25). I don't have this-- would love to purchase one for myself but I don't see a price for just one.
    http://www.hcmarketplace.com/prod-8923/The-Physician-Documentation-Improvement-Pocket-Guide-pack-of-25.html

    Debbie





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