Queries to surgeons

rabiajalal

What is the best response to a surgeon who asks "Why should I do the hospital's bidding and help with coding"? I explained that specific documentation is required for quality purposes and medical necessity and CMS etc etc. This was then followed by " My documentation is fine".
Advice?

MMascarenaz

Here is my spill:)

As the provider it is your medical judgment in regards to the appropriateness of the diagnosis being queried. I have found opportunity in bridging the gap between bedside care and the documentation necessary to reflect the quality care, severity of illness, risk of mortality and resource consumption. Basically the documentation is converted to numbers that become extractable data in numerous aspects of review for the health institution (ex: Case Mix, Relative Weight per Diagnostic Related Group utilized to calculate reimbursement, Mortality Index, Hospital Compare, Leapfrog, and so much more). In addition, this will also represent the providers quality of practice attracting future cases and supportive staff for the environment they will provide care.

morris-jeff@CooperHealth.edu

A Physician Advisor or CMO should step in and have this conversation. Yes, the MD's pro fee billing is separate and that's usually all they worry about. But, if they want a new Davinci robot, OR expansion, additional equipment, etc... they need to contribute to the hospital documentation to ensure that their patient's SOI and ROM are accurately reflected. If they call everything "postoperative" and don't understand queries then the hospital is impacted negatively financially and quality wise. 


Hope this helps!

evanspx@sutterhealth.org

As others have so accurately stated, if the Surgeon wants his or her risk-adjusted data to be accurately compared and reported in the public domain, it is vital that all pertinent risk factors  and secondary conditions are accurately documented and coded.  A hernia repair on a patient with a BMI of 45 may be more complicated than a patient with a BMI of 25, as well as any treatment rendered during the recovery period.

P.. Evans,  RHIA, CCDS

morris-jeff@CooperHealth.edu

evanspx@sutterhealth.org said:

As others have so accurately stated, if the Surgeon wants his or her risk-adjusted data to be accurately compared and reported in the public domain, it is vital that all pertinent risk factors  and secondary conditions are accurately documented and coded.  A hernia repair on a patient with a BMI of 45 may be more complicated than a patient with a BMI of 25, as well as any treatment rendered during the recovery period.

P.. Evans,  RHIA, CCDS

Well stated!

rabiajalal

These are great points for surgeon education!

Thank You!