HELP with irritated doc with Pathology queries

lconaway@altoonaregional.org

So... this is our issue.  We put on the typical query when a path report comes back to see if they concur or do not concur with the findings.  He seems to have real concerns about the legal aspects of committing to a particular diagnosis.  Another physician would like us to add a a disclaimer type statement.  Has anyone heard from docs with similar concerns?  Any advice?  We have already informed him that coders can not simply code from the path report. 

 Disclaimer:    " I am not the pathologist and can not verify the accuracy of the interpretation; the given diagnosis, however, is not incompatible with the range of differential diagnoses relevant to this admission."

Email from the Musculoskeletal Oncologist :

The problem is the progress note addendum.  That adds to the medical record.  That is something on which I could be questioned in a deposition or trial.  That is the issue with this inane process.
I need to, and will, protect myself if something is put into the medical record.
This process is capricious:  as I've said, I have many path reports per week, yet sometimes it draws a nosy coder.
And path reports may or may not have a "clinical impression," and what if it is not consistent?  Does this therefore start a chart war with profound medicolegal repercussions simply because a coder sitting at home is not satisfied.
The path is as the path is.  There ARE times that we disagree, but that occurs in a multidisciplinary conference where multiple docs (several pathologists, several radiologists, and several surgeons) confer on the result that is given, and sometimes we DO ask for a path addendum that DOES change the diagnosis.  That's a really serious process for the pathologists, and does expose them to risk.  It is also a slow process, and does not happen in a timeframe that will satisfy the medical records computer.  But we do it for the patients.  To do that in a wanton manner in a chart is really bad.
Coders should simply code what the path says.  In 99+% of the time, my opinion regarding the path is entirely irrelevant.

evanspx@sutterhealth.org

You have my sympathy as the respondent, in my opinion, is being unreasonably contentious.  Speaking as a 'nosy' coder, we only want to ensure the findings of the professional pathologist are recorded.  As you know,  coding rules clearly state no one may code directly from the pathologist recorded impression.It is the responsibility of the ATTENDING of record to 'make the call' if there is any dissonance charted.  I can only state a query form such as below has served me well, and offer this to you.
*****************************************************************************************************************************Query:

On DATE the pathologist has identified ***.

　 Please validate this diagnosis. 　 Abnormal findings (laboratory, x-ray, pathologic, and other diagnostic results) are not reported unless an authorized provider indicates their clinical significance. 　 You may answer this Query by marking the checkbox(es) below or using free text at the ( * ) if appropriate. Provider Query Response:*

Clinically significant

Not clinically significant

Unable to determine

Other / clarification of findings (please specify)*

The purpose of this query is to ensure accurate coding, severity of illness and risk of mortality compilation. When responding to this query, please exercise your independent professional judgment. The fact that a question is asked does not imply that any particular answer is desired or expected.

lconaway@altoonaregional.org

Paul - thank you and I agree!  Maybe using your query form instead of ours that asks " to agree or not agree with path findings"  will make him more comfortable.  (Although, he is especially colorful and a tad difficult to deal with...as you probably noticed)

SIgned,  A "nosy" CDI

evanspx@sutterhealth.org

Indeed..quite notable.  Good luck ! 

Paul E

lprescott1

This is an interesting conversation,I would add to the above and suggest this provider requires a great deal of education. the comments above of "nosy coders" very much indicates this provider has no understanding of the process of code assignment, the need for accurate code assignment and the fact you are actually assisting him in obtaining an accurate picture of this patient's conditions to support SOI/ROM, risk adjustment, quality measures etc. If you have a physician adviser, I would certainly recruit assistance in communicating with this provider. If you have no adviser or champion, I would enlist support through administration. The response in that email need to be addressed, and demonstrate the importance or need of an escalation policy and support for CDI practice.