Querying providers on pathology results after the patient has been discharged - is it ethical?

gilljudi@hotmail.com

I recently sent a query to one of our surgeons related to the pathologist's findings on the surgical sample he had sent from the kidney mass he had resected. The pathology results were not available before the patient was discharged and so the surgeon did not have this information during the inpatient admission. Many providers at the medical facility where I work are concerned when answering this query because they feel they are being asked to attest to something they didn't have timely (during the inpatient admission) knowledge of.

Have other providers, CDIs and coders run into this situation and what was the education you shared with the provider?  Thank you!

Judi Gill, RN, BSN, CCDS

evanspx@sutterhealth.org

The fact the nature of any neoplasm is confirmed after D.C does not present an ethical challenge.  Since these path reports are used to precisely define the nature, site, location, etc, of the mass, a query is required.  Lacking a query referring to the nature of the neoplasms, the data for the encounter may be incorrectly reported to the Tumor Registry, the CDC, and so on.  Further, the nature of the disease managed and treated by the Surgeon may not be accurate.  The fact the surgeon ‘did not have the results until after discharge’ does not negate the need for a query.   Surgeons and Oncologist WILL refer to the findings of the Pathologist as they initiate any other required treatment for cancer that may be present, such as chemotherapy, immunotherapy, and so on.  

We use above when we discuss this with surgeons.


Paul Evans, RHIA, CCDS

tvansickle

We have a surgeon who stated he will always agree with the path report and does not want to be queried on the findings? Stated he will sign something if he needs to, but doesn't want a query. Trying to figure out a process for this. Any suggestions? 

evanspx@sutterhealth.org

Facilities may not code directly from a pathology report.  I can’t think of a compliant work around other than a query.

tvansickle

My thought as well. 

MMascarenaz

Would an attestation on the Path Report by the provider be acceptable to capture the specificity?

ebraun

tvansickle said:

We have a surgeon who stated he will always agree with the path report and does not want to be queried on the findings? Stated he will sign something if he needs to, but doesn't want a query. Trying to figure out a process for this. Any suggestions? 

We have the same issue.  We have just continued to educate on the coding "rules" we have to follow.  This is the biggest pain point for our physicians in regards to queries.  They hate the path agreement queries!  I wish there was a way to get around it, but I don't know of anything compliant we could do.

ellen.jantzer@asante.org

We have had these same issues. Rather than ask the surgeons if they "agree with the pathology findings", we have better success if we ask them to provide an "updated diagnosis" based on the results of the path report. 

Regarding the ethical question. During a meeting, my MD champion bluntly asked the surgeon, who did not want to answer a pathology query, "well, what did you tell the patient?"..... because of course the Doc told the patient exactly what was found on the path report. Also, when I educate surgeons, I remind them that cancer in a path report just proves they made the correct decision to remove that organ and I want to make sure the documentation and coding gives him credit for their excellent work.

Regarding the "I always agree with the path report so don't query me" comment.... remind the MD that the coding rules are there for a good reason. We DON'T want coders or CDI to assume.... we want to ask the Doc for their clinical opinion... these rules put the MD in the drivers seat where they belong.