KaylaRieken
True Blue
If my physician reviewed an ultrasound image and then a kub image and documented their interpretation, would they receive 4 total points? Are these counted as 2 points each?
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Wiki Data Points
- Thread starter KaylaRieken
- Start date
Pathos
True Blue
An Ultrasound and KUB (Kidney, Ureter, Bladder) would both fall under the "Radiology" section in Amount of Data reviewed. Depending on documentation and medical necessity, I could possibly see the following scenarios:
1) "Simple" review of both types of images, with results in the documentation. No summary of either type. Total = 1 point.
2) Documentation fully supported an Independent review and summaries on both studies (provider interpretation before the radiologist had a chance to review and comment). Total = 2 points.
3) US had a simple review, and KUB had an independent review with full and appropriate summary. Total = 3 points.
NOTE: Personally, I believe that when providers provide an "Independent review + summary", I often bring up many ethical questions. The independent review is meant for situations where the provider cannot wait for the interpretation from the radiologist/pathologist/etc. and just need the answer(s) ASAP. This makes good sense in a critical hospital setting, but I struggle to find the logical reasoning (and medical necessity) in an office PCP setting. My point here is while "Independent review" IS an option within the "Amount of Data reviewed" section, I would always keep medical necessity in your opus. Did the provider really need the answers right now, or can they wait until the official review has happened? When a provider habitually does Independent reviews on ALL of their ordered studies, and this provider is in a regular PCP setting, then perhaps some provider education might be warranted. My concern is that the provider might be milking the Marshfield Audit Tool in getting points where points were not meant to be had.
Hope this helps!
1) "Simple" review of both types of images, with results in the documentation. No summary of either type. Total = 1 point.
2) Documentation fully supported an Independent review and summaries on both studies (provider interpretation before the radiologist had a chance to review and comment). Total = 2 points.
3) US had a simple review, and KUB had an independent review with full and appropriate summary. Total = 3 points.
NOTE: Personally, I believe that when providers provide an "Independent review + summary", I often bring up many ethical questions. The independent review is meant for situations where the provider cannot wait for the interpretation from the radiologist/pathologist/etc. and just need the answer(s) ASAP. This makes good sense in a critical hospital setting, but I struggle to find the logical reasoning (and medical necessity) in an office PCP setting. My point here is while "Independent review" IS an option within the "Amount of Data reviewed" section, I would always keep medical necessity in your opus. Did the provider really need the answers right now, or can they wait until the official review has happened? When a provider habitually does Independent reviews on ALL of their ordered studies, and this provider is in a regular PCP setting, then perhaps some provider education might be warranted. My concern is that the provider might be milking the Marshfield Audit Tool in getting points where points were not meant to be had.
Hope this helps!
KaylaRieken
True Blue
Also have another question about reviewing other physician's records. If my physician sees an inpatient and looks at another physician's progress notes and does a summarization is that ok to give them 2 points for this? Is this even ok to do this in a hospital?
Pathos
True Blue
I keep thinking about the medical necessity on this. Is the provider just trying to score 4 points for their work, or did they really need to document another provider's documentation into a summarization? I also question the practice of providers doing this habitually, and especially in a non-hospital/critical setting.
I actually had this question brought up in my previous work place, and we concluded that it all depends on whether the other provider is from the same department/specialty and practice as the main provider. If they both are from the same department and specialty, then we would not allow the 2 points, or even the 1 point for reviewing their documentation. If the other provider was different, then depending on documentation, we allowed 1 or 2 points (the latter being rare).
So in short, in practice you could probably give the 2 points if documentation supports; HOWEVER medical necessity ALWAYS trumps over any points or level assigned by the provider and/or coder. As medical necessity can be quite intangible, auditing these types of charts can get very tricky, which eventually gave birth to the Marshfield Clinic Tool. I have not yet seen any references that would prohibit a provider to do what you stated above.
I actually had this question brought up in my previous work place, and we concluded that it all depends on whether the other provider is from the same department/specialty and practice as the main provider. If they both are from the same department and specialty, then we would not allow the 2 points, or even the 1 point for reviewing their documentation. If the other provider was different, then depending on documentation, we allowed 1 or 2 points (the latter being rare).
So in short, in practice you could probably give the 2 points if documentation supports; HOWEVER medical necessity ALWAYS trumps over any points or level assigned by the provider and/or coder. As medical necessity can be quite intangible, auditing these types of charts can get very tricky, which eventually gave birth to the Marshfield Clinic Tool. I have not yet seen any references that would prohibit a provider to do what you stated above.