Out-Patient Clarification vs request to request to screen?

We know that we can prospectively (prior to visit), concurrently, or retrospectively submit a CDI clarification, if we meet the criteria.

In the out-patient world, there is also a whole quality component; foot exams needing to be done, eye exams, A1C captures..etc.

Is it appropriate to request the provider do a screening for a medical condition?


Screening of an at risk patient requested.

This patient has known DM II.  Please perform an annual foot exam to determine the patient's status and if there are any sign/symptoms of neuropathy or PVD.  Please treat/manage and document as appropriate based on your findings.


  • Hi Suiterjamese,

    This question took some thought process but from what I can deduce you want the provider to screen for a condition because of patient's risk factor?

    Were there clinical indicators to suggest patient is developing complications due to an underlying condition?

    I think it can get dicey to request a provider to perform a screening, this can be viewed as stepping out of the CDI realm of documentation improvement. We wouldn't want to tell a provider how to take care of his or her patient. For that reason I will say it is not appropriate.

    But that is just my opinion.

  • Screening requests would be based on medical standards, not just for CDI condition opportunity.  In out-patient and MIPS you are evaluated on capturing a lot of different data - Screenings of feet, screenings of eyes, A1Cs, iFOBTs..etc

    How are people addressing this aspect?

  • Thank you for clarifying the question, with capturing each MIPS measure we employed our EHR system to trigger a reminder to the clinician for each measure whether its a process or outcome measure. Take for example the Measure 1 which is an outcome measure: Diabetes: Hemoglobin A1c Poor control our system alerts the provider to address this issue next time the patient presents or if the A1C is out of control it alerts the provider to request the patient to come in for a prompt checkup. EHR system is helpful in keeping track of the outcome measures. This measure is part of our data validation for glycemic management services. 

    For process measure such as the one you described in your question: Diabetes: Medical Attention for Nephropathy, measure ID 119, we utilize a combination of automation and manual tracking. We compiled a list of all of the diabetic patients seen at the practice into excel spreadsheet. Each diabetic patient account is flagged in the scheduling system to alert the nurse to review a checklist of questions relating to foot and eyes symptoms. For example the foot exam questions:

    Question 1: History of foot ulcer?

    Question 2: Current foot ulcer?

    Question 3: Current toenails thick or ingrown?

    Question 4: Current callus buildup?

    Question 5: Current swelling?

    Question 6: Current elevated skin temperature?

    Question 7: Current muscle weakness?

    Question 8: Can the patient visualize bottom of his/her feet?

    Question 9: Patient wearing improperly fitted shoes?

    The provider reviews the patient's responses to the questions and based on his or her discretion can ask the questions again or proceed with the foot exam. We then record the date and performing provider on the spreadsheet.

    I think the solution to the question you asked is building a process that flows with patient care that also allows your practice to collect MIPS data simultaneously. 

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