Ultrasound Arterial and Venous Order Changes
In early October, changes will be made to CareLink Orders relative to Arterial and Venous Ultrasound Orders as follows:
A new outline has been created for US Arterial Extremity Exams to ensure correct ordering of these diagnostic exams. See screen print below for more details.
The following tests will be added to the Venous Duplex Legs outline. Please note these tests will ONLY be available via the outline.
US Duplex Venous Insufficiency Bilateral
US Duplex Venous Insufficiency Right Unilateral
US Duplex Venous Insufficiency Left Unilateral
Case Management Forms Moved
In order to improve access to case management forms, the forms were moved between the Consultation and Physician Orders folders within the Medical Records tab in August.
The following guidelines are intended to assist you in meeting insurance guidelines while still giving quality care:
- Admit patients who need the intensity of services only available in the hospital. Patients cannot be admitted for convenience, patient request, or to expedite a workup.
- Charts are reviewed to ensure patients meet admission status standards established by Medicare and private insurers, along with compliance with certain Illinois laws. Document clearly the reason for admission and need for inpatient level of care. Notes must be legible and informative. Medicare says if they cannot read it, they will not pay you.
- Talk to the nurse and case manager daily about your patients; provide an update on your plans for the day, discharge planning, social issues, insurance issues.
- Document all diagnoses to the highest specificity and without abbreviations, such as acute decompensated systolic heart failure, hyponatremia due to diuretics, acute blood loss anemia, appendicitis with dehydration.
- Observation status is for patients who may stabilize in 24 hours, such as asthma exacerbation, mild CHF exacerbation, dehydration from diarrhea, chest pain with normal EKG and initial enzymes, breakthrough seizure, TIA. If the patient does not improve, you can then "admit" them with an order to admit to inpatient. Inability to ambulate in the elderly will not qualify for inpatient status; use observation or outpatient status and talk to your case manager right away.
- Three overnights do not qualify for SNF. They must be medically necessary days. Make no promises to family members.
- Direct admissions must meet the same rigorous criteria as ED admissions. Do not use direct admit as a way to bypass the ED for minor issues.
- Patients with back pain rarely require inpatient admission. Place them in observation, if medically appropriate to rule out cord compression, abscess or tumor and discharge on oral analgesia. If they can eat, they can take oral narcotics.
- If you suspect a patient's pain is drug-seeking, look up their narcotic history on the Illinois Controlled Substance Database at ilpmp.org. Order IV narcotics as slow IV or subQ. Abusers often insist on IV push at a proximal port and refuse subQ dosing.
- Patients requiring narcotics for abdominal pain with a normal workup may have "narcotic bowel syndrome" which gets worse with narcotics.
- Patients kept overnight for routine recovery after a surgery or procedure should not be placed on observation status-use outpatient extended recovery.
- Do not work up incidental or long-standing issues while a patient is hospitalized, such as chronic anemia, long-standing headaches, arthritis. Limit treatment to the admitting problem. Additional testing adds expense without additional reimbursement to cover that cost.
- Use protocols when available, such as CHF, pneumonia, TIA, stroke and VTE prevention. We report adherence to protocol measures to Medicare and other regulatory bodies. That information is now starting to show up on publically available websites.
- Do not keep a patient an extra day for a minor abnormality such as hypokalemia or an elevated BP. Give an extra dose and recheck the lab in a few hours, not the next day. Think to yourself "Would I admit this patient if they had this abnormality in my office?"