9 minute read
PHYSICIAN CONNECTION
Medical Documentation Tip o’ the Month ~or~ How to Survive the Government’s Documentation Rules
What Caused Your Patient’s Pneumonia?
The Federal Government has enough regulations to handcuff any coder and significantly impair his or her ability to demonstrate how sick your patients are.
Here’s what you already know: All pneumonias can be thought of as having a causative organism and/or mechanism of action e.g., aspiration.
Here’s what you may not know: Pneumonia will, by default, code to a “simple pneumonia” unless a suspected causative organism or mechanism of action is specified in the physician documentation. For example, community-acquired pneumonia, healthcare associated pneumonia, pneumococcal pneumonia, and viral pneumonia all code to “simple pneumonia”. Alternatively, aspiration pneumonia, Staphylococcal pneumonia, most Gram-negative pneumonias, many fungal pneumonias, and pneumocystis pneumonia in patients without HIV disease all code to “respiratory infections and inflammation.”
Additionally, the sputum culture results on the lab report will not suffice unless you connect the results to the patient’s pneumonia in your notes or discharge summary. Therefore, unless you document the causative agent, the case will code to simple pneumonia. While, it may be clear to you that an obtunded nursing home patient with a right middle lobe infiltrate has aspiration pneumonia, the coder is not permitted to make the same logical leap and code aspiration pneumonia unless you document that you think this is the cause.
Furthermore, if you document only “aspiration” without “pneumonia” or “pneumonitis”, then the coder will not capture a pneumonia at all and may code a foreign body in the respiratory tree!
Let’s look at a clinically similar scenario and possible coding outcomes:
Your 56-yo patient is homeless, found in a gutter, clutching a bottle of Jim Beam, and presents with pneumonia and RML infiltrates. You admit the fellow to treat aggressively.
MS DRG Description Average Medicare Compensation
Average Length of Stay 195 Simple pneumonia & pleurisy w/o CC/MCC $4,021.88 2.5 days 179 Respiratory infections & inflammations w/o CC/MCC $5,271.70 3.0 days
Why the difference?
In the first scenario, you documented "pneumonia" in the progress notes. Conversely in the second scenario, you documented “pneumonia: likely due to aspiration” in your progress notes and discharge summary. As a result, your patient was approved for a longer hospital stay to address his more complicated pneumonia under your expert care.
The moral:
Always indicate the organism (if known or presumed) and/or whether you suspect the mechanism of action was a cause of the pneumonia.
New Implicit Bias Training Requirement
The Michigan Department of Licensing and Regulatory Affairs (LARA) will require Implicit Bias Training for physicians (and other health care professionals), effective June 1, 2022. The requirements apply to both new applicants as well as those renewing their existing licenses or registrations.
An applicant for license renewal shall have completed a minimum of 1 hour of implicit bias training for each year of the applicant’s license or registration cycle. An applicant for new licensure, both limited and medical, shall have completed a minimum of 2 hours of implicit bias training within the 5 years immediately preceding issuance of the license or registration.
Please note, the implicit bias training for licensure must “provide opportunities for interaction among participants and with the instructor” to meet LARA requirements
For more information on the Implicit Bias requirement and any other issues regarding physician licensing, please visit: michigan.gov/lara
Thank as the Exclusive
You 2022 Miracle Popcorn Popper for Hurley Children's Miracle Network Hospital.
welcome new providers
BEHAVIORAL HEALTH Joshua Nnanji, MD
Adolescent Psychiatry Hurley Adolescent Behavioral Health Unit 1 Hurley Plaza, 3D Flint, Michigan 48503 Office Phone: 810- 262-7380 Office Fax: 810-262-4768 Office Manager: Debra McCovery
EMERGENCY MEDICINE Gina Eovaldi, PA-C
Physician Assistant Hurley Medical Center 1 Hurley Plaza, ED Flint, Michigan 48503 Office Phone: 810-262-9020 Office Fax: 810-760-0853 Office Manager: Melanie Krznarich
PEDIATRICS Minkyung Choe, MD
Neonatology Hurley Medical Center One Hurley Plaza, 2N NICU Flint, Michigan 48503 Office Phone: 810-262-9026 Office Fax: 810-262-9158 Office Manager: Jennifer Brown
MEDICINE Chelsea Bales, PA-C
Physician Assistant Cardiology Institute of Michigan 5100 Gateway Centre Blvd Flint, Michigan 48507 Office Phone: 810- 733-6480 Office Fax: 810- 733-6483 Office Manager: Nancy Murdock
Mohamed Gismalla, MD
Internal Medicine
Roxanne Klenk, NP Nurse Practitioner
Ali Zreik, MD
Internal Medicine
MEDICINE/PEDIATRICS Abdul Kazmi, MD
Internal Medicine/Pediatrics
Ahmed Qadir, MD
Charles Swanson, MD
Internal Medicine/Pediatrics
Please take the CME Needs Assessment Survey and be eligible for the gift card drawing!
In order to meet your educational needs and relicensure requirements, please complete a survey using any of the following methods:
• Type the link below in your Internet browser: https://www.surveymonkey.com/r/5YTDCJS
• Visit the Hurley website at: www.hurleymc.com > Education & Research > Continuing Medical
• On any computer in the Hurley Physician’s Lounge (non iSITE), look for the “2022 CME Needs
Assessment” icon on the desktop screen
• Visit the Hurley INTRANET Homepage on any computer at Hurley, under Frequently Used
Links, click on “CME Needs Assessment Survey”.
If you have any questions, please contact the CME Department at 810.262.9142.
What is Physician Support Line?
Physician Support Line is a national, free, and confidential support line service made up of 600+ volunteer psychiatrists, joined together in the determined hope to provide peer support for our physician colleagues and medical students. Physician Support Line was created with the mission of physicians supporting physicians as we navigate the many professional and personal intersections of our lives.
Physician Support Line promises to provide emotional support and a safe holding space for physicians and medical students
PHYSICIAN SUPPORT LINE: (888) 409-0141
• Free & Confidential • No appointment necessary • Available 7 days a week 8:00AM - 1:00AM ET Learn More: www.physiciansupportline.com
physician connection Hurley Online CME
To get FREE continuing medical education online, please visit: education.hurleymc.com/cme/ calendar for the following topics that have been approved for AMA PRA Category 1 Credit ™:
• Drug Endangered Children • Pediatric & Adolescent Obesity • Thyroid Cancer Management • Impact of Racism on Children and Adolescents
CONTINUING EDUCATION REQUIREMENTS FOR MICHIGAN MEDICAL DOCTORS
Authority: Public Act 368 of 1978, as amended
REQUIREMENTS FOR RENEWAL
The continuing education requirements apply to every physician renewing a Michigan medical license who has been licensed in the 3-year period immediately preceding the application for renewal. The requirements apply whether or not the physician is actively engaged in the practice of medicine. No one, including medical school faculty and resident physicians, is exempt from this requirement.
Each medical doctor is required to complete 150 hours of continuing education in courses or programs approved by the Board of Medicine, of which a minimum 75 hours of the required 150 hours must be earned in courses or programs designated as Category 1 programs.
A minimum of 1 hour of continuing education must be earned in the area of medical ethics. A minimum of 3 hours of continuing education must be earned in the area of pain and symptom management.
NOTE: LARA trainings are separate from Continuing Education requirements. • LARA requires a one-time mandatory training in Opioids and Controlled Substances
Awareness and Human Trafficking. • LARA requires Implicit Bias Training for new applicants, as well as those renewing their existing licenses or registrations.
An applicant for license renewal shall have completed a minimum of 1 hour of implicit bias training for each year of the applicant’s license or registration cycle, and every renewal cycle thereafter.
Hurley offers the following free CME on Demand courses that fulfill requirements, training, and are approved for AMA PRA Category 1 Credit ™
• Ethical Principles – Choosing Wisely Please visit: education.hurleymc.com/cme/calendar (This activity fulfills the CE requirements for medical ethics.) • Managing the Chronic Opioid User (This activity fulfills the CE requirements for pain and symptom management.) Coronavirus Educational Resources • Human Trafficking: the Role of the Healthcare Provider There is a Novel Coronavirus Education Resources webpage on the (This activity fulfills the LARA training standards for identifying victims of human trafficking requirements.) ACCME website at www.accme.org/coronavirus-resources that includes a
Please visit: education.hurleymc.com/cme/calendar list of accredited continuing education (CE) activities and additional resources that can help the clinician community respond to the novel Coronavirus coronavirus public health emergency. The majority of the CE activities are Educational Resources There is a Novel Coronavirus Education Resources webpage on the ACCME website at www.accme.org/ Free. coronavirus-resources that includes a list of accredited continuing education (CE) activities and additional resources that can help the clinician community respond to the novel coronavirus public health emergency. The majority of the CE activities are free.
HURLEY REGULARLY SCHEDULED SERIES (RSS)
CREDIT CONTACT NAME RSS TITLE HOURS DEPT LOCATION DAY & TIME & NUMBER
Multidisciplinary Tumor Board
1.00 Oncology Virtual Wednesdays, 7:00-8:00 AM
WEEKLY
Robyn Hatch 810-262-9585
Pediatric Grand Rounds 1.00 Pediatric Virtual and Ed Center Rm 123 Wednesdays, 8:00-9:00 AM
WEEKLY
Audrina Roberts 810-262-7045
Pediatric Oncology Tumor Board
1.00 Oncology For Location, Day, and Time, please call the Pediatric Dept at 810-262-7045 Audrina Roberts 810-262-7045
Surgical Conference 1.00 Surgery Virtual and 7B Conference Rm
Surgical Critical Care Journal Club
1.00 Surgery Virtual and 7B Conference Rm 3rd Friday, 7:00-8:00 AM
MONTHLY
4th Friday, 7:00-8:00 AM
MONTHLY
Pauline Tippett 810.262.6823
Pauline Tippett 810.262.6823
Trauma Conference 1.00 Trauma Virtual and 7B Conference Rm 1st Friday, 7:00-8:00 AM
MONTHLY
Pauline Tippett 810.262.6823
