HELP!!! My supervisor thinks WEAKNESS is a chief complaint for dialysis calls

[JPINFV]

JP, think Jeopardy. I honestly do know what 'reason for transport' means on an IFT chart

Ah durrr...

 

[Shishkabob]

EMS just needs to not do the majority of dialysis transports that are currently done...

 

[JPINFV]

EMS just needs to not do the majority of dialysis transports that are currently done...

...the entire medical transport industry needs to be spun off from EMS period, if for nothing else than the fact that different skills are needed for different jobs.

 

[NomadicMedic]

As an additional point to this, new EMTs are often not well educated on how to write charts for routine transports. Many of the dialysis runs will never be paid for because the EMT didn't properly document a medical necessity. If your patient needs to go via BLS ambulance because of aspiration precautions, special positioning, decubs, o2 that can't be self administered... You better document it. Simply writing ESRD or "cannot tolerate wheelchair" will not get your company paid. And like it or not, for IFT companies, the amount of reimbursement is what drives the business. So, make it a mission to find out the reason each patient requires a BLS ambulance for transport and note it in the medical necessity box.

 

[jjesusfreak01]

As an additional point to this, new EMTs are often not well educated on how to write charts for routine transports. Many of the dialysis runs will never be paid for because the EMT didn't properly document a medical necessity. If your patient needs to go via BLS ambulance because of aspiration precautions, special positioning, decubs, o2 that can't be self administered... You better document it. Simply writing ESRD or "cannot tolerate wheelchair" will not get your company paid. And like it or not, for IFT companies, the amount of reimbursement is what drives the business. So, make it a mission to find out the reason each patient requires a BLS ambulance for transport and note it in the medical necessity box.

I agree with this, and it really doesn't make sense. I would think my bosses would want to give us excessive education on this because it gets them paid. What most of the employees at my company do (not me) is write:

"Pt transport is medically necessary due to..."

And then they list all of the patients irrelevant conditions. This annoys the crap out of me, but most of the people at my company have no desire to further their medical education and so they don't have any idea what most of these conditions are regardless. They are afraid to write anything down that wasn't carved in stone by a doctor, forbid anything they came upon in their own assessment. Ugh...this is why I prefer EMS (no medical necessity).

 

[crazycajun]

Really? The patient who is chronically weak is complaining about weakness 6 times a week?

It doesn't matter how many times she calls. Her CC is she is too weak to drive. Therefore her CC is weakness. I am in 911 so we do not Tx dialysis PT's but the principle is still the same.

 

[NomadicMedic]

It doesn't matter how many times she calls. Her CC is she is too weak to drive. Therefore her CC is weakness. I am in 911 so we do not Tx dialysis PT's but the principle is still the same.

Then Medicare will ask, why doesn't she go by cabulance or a medi-transit wheelchair van? Is she bed confined? Dementia? Requires airway monitoring?

You need a MEDICAL reason why a BLS ambulance is necessary. Or, you probably will not get reimbursed for the transport.

 

[akflightmedic]

Then Medicare will ask, why doesn't she go by cabulance or a medi-transit wheelchair van? Is she bed confined? Dementia? Requires airway monitoring?

You need a MEDICAL reason why a BLS ambulance is necessary. Or, you probably will not get reimbursed for the transport.

Understood but you are getting off topic.

The original debate was whether or not weakness would suffice as a CC. Absolutely it would because your chief complaint is supposed to be one to two words describing current issue.

All the rest of the fodder, justification, whatever will follow in your history and exam (if done).

 

[NomadicMedic]

Understood but you are getting off topic.

The original debate was whether or not weakness would suffice as a CC. Absolutely it would because your chief complaint is supposed to be one to two words describing current issue.

All the rest of the fodder, justification, whatever will follow in your history and exam (if done).

Maybe weakness would be an appropriate CC for a 911 call, but not for an IFT, so no... I'm not off topic at all. The patient has no "chief complaint" for a scheduled transport. If there was a box marked chief complaint, it should be filled in "scheduled transport" and the medical necessity can be written in the appropriate box or in the soap.

 

[akflightmedic]

Maybe weakness would be an appropriate CC for a 911 call, but not for an IFT, so no... I'm not off topic at all. The patient has no "chief complaint" for a scheduled transport. If there was a box marked chief complaint, it should be filled in "scheduled transport" and the medical necessity can be written in the appropriate box or in the soap.

Why are you adamant that an individual can not have a chief complaint for an inter facility call? Not every complaint needs to go to an ER for resolution.

By providing the IFT, you are providing exactly what the person needs to resolve their CC.

 

[MrBrown]

You should be providing the "primary problem" rather than chief complaint

For example, if the patient says they are "weak" but their real problem is a massive bloody anterior infarct causing a nunngered SA node, bradycardia and hypotension then "anterior infarct with bradycardia and hypotension" is what you should write.

 

[Aidey]

Semantics. I'm with JP on this one. If your going to be putting diagnoses then they need to be put down as "reason for transport" or "presenting problem".

 

[jjesusfreak01]

For an IFT call:

In the CC field, I usually put the type of transport (dialysis, discharge, doctor's appt, etc) and the presenting problem if I know it. I write the medical necessity in my narrative.

For an EMS call:

Chief Complaint is whyever they called for EMS or whatever the major problem is when we get there.

 

[Frozennoodle]

Exactly. You can always explain it in your narrative.

I transported a patient yesterday who was burping, had a blood pressure of 220/130, and lower extremity weakness. My chief complaint was the HTN and weakness. She complained of burping but that's not why I transported her nor was it the reason she was seeking treatment.

 

[Frozennoodle]

It doesn't matter how many times she calls. Her CC is she is too weak to drive. Therefore her CC is weakness. I am in 911 so we do not Tx dialysis PT's but the principle is still the same.

But it's not even the same thing. Your C/C is the reason you're brining the patient to the ER, or to whatever facility, for whatever transport. You're not treating the patient for weakness! At no point is anyone ever going to address the weakness on this transport! It's the ESRD that is being treated! If someone was having a major bleed from a gunshot and had weakness would you put the C/C as weakness or the gunshot for which the patient is actually going to be treated for?

 

[akflightmedic]

But it's not even the same thing. Your C/C is the reason you're brining the patient to the ER, or to whatever facility, for whatever transport. You're not treating the patient for weakness! At no point is anyone ever going to address the weakness on this transport! It's the ESRD that is being treated! If someone was having a major bleed from a gunshot and had weakness would you put the C/C as weakness or the gunshot for which the patient is actually going to be treated for?

End Stage Renal Disease is a diagnosis with many symptoms which include weakness.

Chief Complaint could indeed be their weakness.

The dialysis could relieve their weakness at which point they would no longer have a chief complaint.

At this point it is simply semantics, weakness is an acceptable CC but the best solution is to follow your service's direction and insert whatever gets the bills paid which in turn pays your salary provided you are not lying or breaking any laws with your documentation.

 

[Journey]

It's the ESRD that is being treated! If someone was having a major bleed from a gunshot and had weakness would you put the C/C as weakness or the gunshot for which the patient is actually going to be treated for?

Don't assume every dialysis patient has ESRD. It could have been a trauma such as a GSW with all the complications that go along with it and the dialysis may only be temporary. Several dialysis patients do not have kidney disease as a stand alone primary diagnosis and will have varying degrees of acute and chronic renal failures for classification of the stages. When a doctor decides a patients level of care and type of transport, they take this into consideration which may not always be obvious to you without knowing the criteria for the stages and the risks associated with each.

 

[usalsfyre]

If someone was having a major bleed from a gunshot and had weakness would you put the C/C as weakness or the gunshot for which the patient is actually going to be treated for?

The chief complaint would be weakness. This is what the PATIENT is acutally complaining of, often placed in quotations and the patient's exact words. This is similar to a triage complaint The field impression/differential diagnosis is hemmorrhage from a gunshot wound, because your not actually treating the gunshot either, your treating the hemorrhage associated with it.

Small, but important differences in doccumentation. Being able to speak a common langauge with other healthcare providers reduces confusion.

 

[usalsfyre]

At this point it is simply semantics, weakness is an acceptable CC but the best solution is to follow your service's direction and insert whatever gets the bills paid which in turn pays your salary provided you are not lying or breaking any laws with your documentation.

For the OP, this is probably the best advice on here.

 

[EMTswag]

yeah generally where I work when they dispatch you they will give you a short "BLS for" message. like "BLS b/c pt unable to safely be transported in a wheelchair" but thats not a chief complaint. Weakness would probably have been the BLS justification.