Patient Discharge Status

lisa_garofolo

I'm not sure if this is the right forum, but any insight would be appreciated.  I have a question related to inpatient discharge disposition coding.  When a patient is discharged to a "nursing home facility", how do the inpatient coders at your facility confirm which level of care the patient is discharged to? How do you know when to use 03-skilled versus 04-intermediate care? Some nursing home facilities are licensed for multiple levels of care. 
Thank You! 
Lisa Garofolo
Compliance Analyst
URMC

evanspx@sutterhealth.org

When I was working as a coder, we had an extensive list of facilities documenting the licensure of each site.   We also reviewed the notes of the Case Manager to see precisely where the patient would be transferred, and we checked the CM notes against the MD notes.

Paul

lisa_garofolo

Okay, Thank You Paul! Our coders have been struggling with this lately. It's helpful knowing what process others follow. Appreciate It!

evanspx@sutterhealth.org

It can be more problematic than one would think in that sometimes the CM notes conflict with the MD notes.   I suggest that HIM management and CM meet and offer guidance for coding/CDI teams as to how to review the record and what to accept as definitive documentation.

Paul

lisa_garofolo

That is a good suggestion! I am going to check in with HIM today and mention this idea. Thank You!

BTC2018

I would go a step further and, with CM and HIM/Coding/CDI, a policy and procedure should be written to define responsibilities and who should perform follow-up and the lines of reporting and communication. CDI should include discharge status problems in their metrics.