Mid Level Providers answering Queries

sharon.truitt

Many physicians utilize mid level providers. Do any facilities accept the response from a mid levl provider on a Query for documentation and coding clarification? If yes, please share your experiences and if no, please share why. Thank you

Sharon Truitt, LPN, CCS
HIM Coding Supervisor

robert.hodges2

We have NP's and PA's here and routinely query them, but only if they are the author of the note. But if a NP's note addresses a query that was sent to a physician, I make note of it but still expect the physician to address it in their note.

Robert

Robert S. Hodges, BSN, MSN, RN, CCDS
Clinical Documentation Improvement Specialist
Aleda E. Lutz VAMC
Mail Code 136
1500 Weiss Street
Saginaw MI 48602
 
P: 989-497-2500 x13101
F: 989-321-4912
E: Robert.Hodges2@va.gov
 
"We are dealing with Veterans, not procedures; With their problems, not ours." --General Omar Bradley

evanspx@sutterhealth.org

As NP and PA are 'licensed in our state to establish a diagnosis', they
may answer a query for a case for which they are actively involved.



Paul Evans, RHIA, CCS, CCS-P
Supervisor, Clinical Documentation Integrity, Quality Department
California Pacific Medical Center
2351 Clay #243
San Francisco, CA 94115
Cell: 415.637.9002
Fax: 415.600.1325
Ofc: 415.600.3739

Unknown

We use NPs who have been credentialed by our facility. They exist
currently in Cardiology and Wound Services. The state of CA, as do most
other states allow NPs to write orders and prescriptions.

Donna Kent, RN, BSN, CCDS
Manager, Clinical Documentation Integrity Program
Clinical Quality and Accreditation
Torrance Memorial Medical Center
ph.:310 784-6884 fax:310 784-6899
donna.kent@tmmc.com

catladyrn

Interesting question. I believe, regardless of licensing statutes, that you would need to review your hospital's bylaws and policies regarding physician extender documentation. Our hospital's coders will not accept documentation not co-signed by a physician.

Renee


Linda Renee Brown, RN, CCRN, CCDS
Certified Clinical Documentation Specialist
Banner Good Samaritan Medical Center

evanspx@sutterhealth.org

Our by-laws, etc, allow one to code directly from notes of PA or
NP....this is also a Coding Clinic stating one may do so. So, we give
notes of NP or PA same weight as an MD...as always, if there is
dissonance in the record, the Attending MD documentation trumps.


Paul


Paul Evans, RHIA, CCS, CCS-P
Supervisor, Clinical Documentation Integrity, Quality Department
California Pacific Medical Center
2351 Clay #243
San Francisco, CA 94115
Cell: 415.637.9002
Fax: 415.600.1325
Ofc: 415.600.3739

katysuegood@gmail.com

This is our experience Renee,

Its not the state credentialing, but the hospital bylaws that stop us from depending on NP's to answer queries.
Our hospital requires that NP's notes be co-signed. Our queries are a part of the permanent medical record so if they were to answer the query soley on the query form, it should not be coded unless it was co-signed by a MD. However, if they address it in their note, it will be coded because their notes are co-signed.
We have some awesome trauma NP's. I have asked them when they see a query on the chart to please address it in the notes and check the box stating "answered in progress note" and sign the query. I ask that they sign the query only so the other providers know that it has been addressed. They often just address it in the progress notes and dont sign. I'm just happy the info made it into the record!

Katy

evanspx@sutterhealth.org

Coding Clinic Reference - Mid-Level Provider

AHA Coding Clinic

sharon.truitt

Thank you all for your responses. Has anyone had any push back from RAC and/or 3rd Party reviewers? If yes, what was the outcome? Have there been any policies developed to address how discrepancies are handled?

I do think that if the hospital bylaws and policies accept this practice and the support from the 2004 Coding Clinic, it can be argued providing that it meets all of the elements such as it is not in direct conflict with what the attending documents. I am concerned retrospectively that the physician that the mid level provider working under is not clearly identified (such as a PA is working for the hospital and not under the responsibility of the attending) and the attending's note or discharge diagnosis is in conflict with the Mid level provider response on the query.

From the responses below, consensus is, it still goes back to the attending validating the information and not standing on the mid level providers response alone.


Sharon Truitt, LPN, CCS
HIM Inpatient Coding Supervisor

kshumpert

We haven't had any issues with RACs regarding the midlevel provider documentation. However, all of our acute care documentation by midlevel providers is cosigned by the supervising physician. I audit the compliance with signatures quarterly.


Kathy
Kathy Shumpert, RN, CCDS

Clinical Documentation Improvement Specialist
Howard Regional Health System
Office 765-864-8754
Pager 765-454-3465
Fax 765-453-8152

When something can be read without effort, great effort has gone into its writing. ~Enrique Jardiel Poncela