How not to cheat Medicare
Nurse Janelle Wissler, blogging on RACmonitor.com, urges hospitals to start the New Year right by not miscoding their insurance claims. Good idea!
New Year's Resolution No. 1: Discard the sports-related mantra that "if you're not cheating, you're not trying hard enough."Instead, keep in mind that just because you CAN get away with something doesn't mean you should. In 2011, let's try to get it right the first time, every time.
But her online test with coding case studies demonstrates how subtle and complicated the process can be. Example:
A patient is admitted in a hypotensive state. Various causes are considered throughout the stay. Consultations are held with cardiology, neurology, nutrition and internal medicine. Occupational therapy consult is obtained. Medications are adjusted according to the medication reconciliation form, and the patient is told to be cautious in standing from a sitting position. Final diagnosis is "hypotension, multifactorial." Do you query the attending physician to determine what he or she feels is the "most likely" cause, or do you assign "hypotension, NOS," which is the highest weighted MS-DRG assignment of the multiple "possible" causes noted throughout the chart?
Who knows? In patients with multiple symptoms, and especially in patients with multiple diagnoses, it's probably not clear-cut even for professionals.
