ED Coding and Reimbursement Alert

Question: When an emergency physician turns an incomplete patient encounter over to a partner due to a shift change, does the physician turning over the patient need to make a note stating something like, "patient turned over to Dr. X at change of shift. She will continue care and make final disposition"? Or does the second doctor just have to sign behind the first?

Michigan Subscriber

Answer: There is no foolproof, ultimate guideline about what to do in this situation -- it's entirely an internal group decision. Although some practices prefer to have the first doctor sign it, and others prefer to have the discharging physician's signature, most groups feel strongly that any physician involved in the patient's care should sign the chart. The issue often becomes one of a productivity-based compensation formula used by the group: Which doctor should get credit for treating the patient?

To distribute revenue fairly, what matters most is that the physicians follow a consistent policy. Most groups gravitate towards the discharging doctor's signature, as that habit tends to incentivize people to tie up loose ends at sign-out. Clinically, the major emergency room decision is usually whether to admit the patient or send her home -- and the physician who determines that disposition makes that choice.

As far as risk management is concerned, your best bet would be to have both physicians sign the chart with a brief note written by the departing doctor, such as, "signed out to Dr. X. CT Scan and repeat belly exam pending." Studies have shown that signed-out patients carry a higher risk, so tightening the flow of responsibility seems prudent.