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



## code3club (Jul 9, 2011)

I got in an hour long yelling match with my supervisor, he thinks WEAKNESS is an acceptable chief complaint for a dialysis call!!!!!  He will not listen to me and it is frustrating me to no end. I know what the chief complaint should be ESRD, Hemodialysis, Dialysis Tx, Renal Disease, Life sustaining hemodialysis take your pick but NOT WEAKNESS. How can I convince my supervisor he is wrong

HELP!!!!!​
                                                                            Thanks, DB


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## MMiz (Jul 9, 2011)

First, welcome to EMTLife!

Why do you need to fight this battle?  It seems like you already tried to discuss the topic and it wasn't productive.


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## akflightmedic (Jul 9, 2011)

Hour long yelling match and you are still employed?

Anyways, he is your supervisor and is this a battle you NEED to fight? Does it make a difference? The answer is no it does not and it only causes you grief and stress.

Why not live to fight another day and let this one go?

FYI, most dialysis patients are weak which is why you are transporting them instead of them going by personal vehicle (bilateral amputations excluded).

So to be blunt, yes their chief complaint could indeed be weakness and their past medical history will show ESRD and then in your notes when you justify your trip via ambulance your run report makes sense to the auditor.

They will read an ESRD patient with weakness is being assisted to dialysis.


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## Aidey (Jul 9, 2011)

My ESP is telling me that billing is kicking back tickets that use "ESRD" as a justification for ambulance transport, hence the supervisor wants people to use something else that will guarantee to get the bills paid. 

Ok, here is the deal.

Do all dialysis patients need ambulance transport? No

Since every dialysis patient does not use ambulance transport "ESRD" is not self explanatory enough to justify paying for an ambulance.

So presumably the dialysis patients who are using ambulance transport have secondary conditions that necessitate their transport by ambulance.*

That is the condition that needs to go down on the PCR. 

For example. "The patient is a 75 yo female who is being transported from Acme SNF to Acme dialysis clinic. The patient is being transported via ambulance because they have R sided paralysis due to a CVA and they have mild dementia, and they are unable to safely sit in a wheelchair without one on one supervision."

Or "The patient is a 75 yo female who is being transported from Acme SNF to  Acme dialysis clinic. The patient is being transported via ambulance  because they are unable to sit in a wheel chair or transfer without 2 person assist due to dementia and chronic weakness due to ESRD, cancer and general poor health". 



*Or they or their family is demanding, or their MD is a lazy twit. Not wanting to wait for the WC van is not a justifiable excuse to go by ambulance, although if you bully your MD enough he might sign the PCS.


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## MrBrown (Jul 9, 2011)

The fail in your supervisor is strong, you need to remove yourself from it before you are drained young one


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## Frozennoodle (Jul 9, 2011)

If the C/C was weakness the Patient should be transported to the ER because that implies that the weakness is unusual for that patient.  The C/C is what the patient is being treated for.

Medical necessity however is why the patient can not go by a wheelchair can and must have an EMS stretcher.  The medical necessity is, "Patient requires EMS stretcher due to weakness and right sided hemiparesis secondary to CVA and prolonged bed bound state causing muscular atrophy; this makes the patient posturally unstable and unable to support self in wheelchair and unable to transfer self requiring 2 persons to move and full assistance with ADL's. Patient also has dementia and attempts to stand on his own causing patient to be a fall risk due to above weakness and needs supervision while en route to prevent patient from standing during transport." or whatever is causing their weakness blah blah blah *sets Medicare on fire and dances on it's ashes*


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## akflightmedic (Jul 9, 2011)

Frozennoodle said:


> If the C/C was weakness the Patient should be transported to the ER because that implies that the weakness is unusual for that patient.  The C/C is what the patient is being treated for.



I disagree. Due to ESRD, they need dialysis 3 x a week or whatever their rotation is. As the time for dialysis approaches, they are becoming weak...this weakness is normal for ESRD patients...this is one of the symptoms on a very basic level.

Therefore to go get their ROUTINE treatment which will resolve the weakness, it is entirely appropriate to put weakness as a CC without the need for an ER.


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## Aidey (Jul 9, 2011)

I agree that there is no need for an ER unless something is significantly wrong or different, and even then I would likely let the dialysis RN make the call unless it was something obvious, like a new onset CVA. However, I still maintain that ESRD is an insufficient explanation. After all, some patients drive themselves to and from treatment.


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## MusicMedic (Jul 9, 2011)

i guess they could be complaining of chronic weakness due to their ERSD.. so then that would make if their C/C. 

a persons c/c doesnt always have to be acute

my C/C right now is muscle soreness cause of the gym! (stupid deadlifts  )

i do agree with the folks above that putting only ESRD with out further explanation is insufficient for billing.


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## Frozennoodle (Jul 9, 2011)

akflightmedic said:


> I disagree. Due to ESRD, they need dialysis 3 x a week or whatever their rotation is. As the time for dialysis approaches, they are becoming weak...this weakness is normal for ESRD patients...this is one of the symptoms on a very basic level.
> 
> Therefore to go get their ROUTINE treatment which will resolve the weakness, it is entirely appropriate to put weakness as a CC without the need for an ER.



You misunderstood my meaning.  If I call EMS for chest pain my C/C is chest pain.  If I call EMS for transport to dialysis my C/C is dialysis tx secondary to ESRD.  The reason I need a stretcher is because of my chronic weakness.  If I needed my weakness resolved I would go to the ER because it's new or more severe than what my norm is and then it would be my C/C.  Dialysis doesn't treat weakness, in fact it induces it.  Dialysis treats ESRD.

The weakness is the medical reason the person needs a stretcher for transport and not a wheel chair ergo, "medical necessity" The reason for the for the transport, or the C/C, is dialysis treatment.


What was the reason you were called out?  To treat weakness or to bring someone to dialysis.


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## usafmedic45 (Jul 9, 2011)

> Hour long yelling match and you are still employed?



Damn...I was going to say that.  Rule #1:  If it's not going to harm a patient or someone else, don't get bent out of shape over it.


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## Shishkabob (Jul 9, 2011)

code3club said:


> I got in an hour long yelling match with my supervisor, he thinks WEAKNESS is an acceptable chief complaint for a dialysis call!!!!!  He will not listen to me and it is frustrating me to no end. I know what the chief complaint should be ESRD, Hemodialysis, Dialysis Tx, Renal Disease, Life sustaining hemodialysis take your pick but NOT WEAKNESS. How can I convince my supervisor he is wrong



Is the patient complaining of weakness?  If so, that's the chief complaint.






akflightmedic said:


> Hour long yelling match and you are still employed?




To be fair, I got in a 45 minute long argument / debate / discussion with my station "captain" last week over EMS, the future of it, what out job is, "you call we haul", etc etc.  Got heated, but all was good as we stayed respectful.


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## HotelCo (Jul 9, 2011)

Linuss said:


> Is the patient complaining of weakness?  If so, that's the chief complaint.



Exactly. You can always explain it in your narrative.


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## ArcticKat (Jul 9, 2011)

Weakness is an entirely appropriate C/C.  ESRD is a disease process, it is not a C/C.  Chief Complaint is just that, the chief complaint as provided by the patient.  When you enter the C/C, that's what you should be entering.  Medical history is not a chief complaint, but it could be the cause of the C/C such as this situation.  

Your patient is weak because of End Stage Renal Disease.  His chief complaint is weakness.  

I would suggest that you do what your supervisor instructs you to do or else look for a new place to work because you aren't doing yourself any favours by trying to force the company to bend to your will.  It is you who must get your stick out of your *** and bend to theirs.


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## JPINFV (Jul 9, 2011)

Point to ponder: Which is more important for a scheduled transport, a "chief complaint" or a "reason for transport?"


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## TransportJockey (Jul 9, 2011)

JPINFV said:


> Point to ponder: Which is more important for a scheduled transport, a "chief complaint" or a "reason for transport?"



What is, reason for transport?


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## crazycajun (Jul 9, 2011)

WOW!!!!! What are EMT instructors teaching these days? A CC is simply the reason why you were called in the first place. For example: You are called to the home of a 71 yo PT complaining of chest pain. After your assessment you find the PT has a LBBB, a history of MI's. The CC is still CHEST PAIN!!!!! Of course you not the 12 lead findings and the PMHx in the narrative but the CC does not change. If you PT calls the ambulance to Tx for Dialysis because she is too weak to drive guess what, Her CC is WEAKNESS!!!


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## JPINFV (Jul 9, 2011)

TransportJockey said:


> What is, reason for transport?




The reason the patient is being transported. At both companies that I've worked for, the "chief complaint" box was actually titled "Chief complaint/reason for transport." It's very possible, for example, that a patient going to or from dialysis or between hospitals or nursing homes, or any other sort of scheduled non-emergent transport doesn't have an actual complaint at the moment of transport. Just because the patient is in a position where there is medical necessity for ambulance transport does not mean that the patient is actively complaining about anything. I agree that "ESRD" or "dialysis" is not a "chief complaint," but both of those valid reasons for transport. To me, trying to saddle every routine transport with a "chief complaint" is simply trying to hammer a square peg into a round hole, and doing it needlessly.


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## JPINFV (Jul 9, 2011)

crazycajun said:


> If you PT calls the ambulance to Tx for Dialysis because she is too weak to drive guess what, Her CC is WEAKNESS!!!



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


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## TransportJockey (Jul 9, 2011)

JPINFV said:


> The reason the patient is being transported. At both companies that I've worked for, the "chief complaint" box was actually titled "Chief complaint/reason for transport." It's very possible, for example, that a patient going to or from dialysis or between hospitals or nursing homes, or any other sort of scheduled non-emergent transport doesn't have an actual complaint at the moment of transport. Just because the patient is in a position where there is medical necessity for ambulance transport does not mean that the patient is actively complaining about anything. I agree that "ESRD" or "dialysis" is not a "chief complaint," but both of those valid reasons for transport. To me, trying to saddle every routine transport with a "chief complaint" is simply trying to hammer a square peg into a round hole, and doing it needlessly.



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


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## JPINFV (Jul 9, 2011)

TransportJockey said:


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




Ah durrr...


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## Shishkabob (Jul 9, 2011)

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


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## JPINFV (Jul 9, 2011)

Linuss said:


> 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.


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## NomadicMedic (Jul 9, 2011)

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.


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## jjesusfreak01 (Jul 9, 2011)

n7lxi said:


> 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).


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## crazycajun (Jul 9, 2011)

JPINFV said:


> 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.


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## NomadicMedic (Jul 10, 2011)

crazycajun said:


> 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.


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## akflightmedic (Jul 10, 2011)

n7lxi said:


> 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).


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## NomadicMedic (Jul 10, 2011)

akflightmedic said:


> 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.


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## akflightmedic (Jul 10, 2011)

n7lxi said:


> 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.


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## MrBrown (Jul 10, 2011)

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.


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## Aidey (Jul 10, 2011)

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".


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## jjesusfreak01 (Jul 10, 2011)

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.


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## Frozennoodle (Jul 10, 2011)

HotelCo said:


> 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.


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## Frozennoodle (Jul 10, 2011)

crazycajun said:


> 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?


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## akflightmedic (Jul 10, 2011)

Frozennoodle said:


> 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.


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## Journey (Jul 10, 2011)

Frozennoodle said:


> 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.


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## usalsfyre (Jul 10, 2011)

Frozennoodle said:


> 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.


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## usalsfyre (Jul 10, 2011)

akflightmedic said:


> 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.


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## EMTswag (Jul 10, 2011)

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.


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## NomadicMedic (Jul 10, 2011)

akflightmedic said:


> 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.



I think you're misunderstanding my reasoning. Of course a PT may have a chief complaint on an IFT. A SNF to a Drs appointment? Sure. A bed confined patient to wound care? Sure. 

I'm talking about the three time per week dialysis patient that is taken via BLS ambulance to the renal center. Those calls are the bread and butter of BLS IFT and if they are not documented with a true medical necessity, Medicare will NOT pay for the trip and may actually audit the service, passed billing and documentation included. I don't understand why this is such a difficult concept for you to grasp. As an IFT EMT writing a PCR, it's important that the actual MEDICAL reason the patient requires a BLS ambulance be documented, not a chief complaint. Its really up to you and your service. You can write weakness or "patient can't tolerate a wheelchair" or whatever you want, but ask the billing department what the reimbursement rate is on Medicare billing and them ask how many are bumped due to improper documentation or lack of medical necessity. 

Then hire an EMS consultant to teach a class to the line staff on reimbursable PCRs and see if that changes. If you've been through a workshop like this, the way you document routine BLS IFT calls will change. For the better.


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## JPINFV (Jul 10, 2011)

n7lxi said:


> As an IFT EMT writing a PCR, it's important that the actual MEDICAL reason the patient requires a BLS ambulance be documented, not a chief complaint.



Here's the catch, however, with that. The most common reason for medical necessity is being bed confined, which carries a very specific set of definitions. A patient who is bed confined, by definition, cannot tolerate a wheelchair. If the EMS provider is documenting first hand that a patient is bed confined, then shouldn't the EMS provider be directly observing that the patient cannot tolerate a wheelchair? If the EMS provider is simply repeating what is reported by nursing home staff, then wouldn't the physician declaration of medical necessity be the primary proof of evidence since anything documented is hearsay? Additionally, shouldn't a test for bed confinement be done for every transport then, especially since PCS forms for routine scheduled transports are kept on file instead of generating a new one every transport? Finally, how many EMS providers are properly trained to determine medical necessity in contrast to just documenting it?


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## EMTswag (Jul 10, 2011)

JPINFV said:


> Here's the catch, however, with that. The most common reason for medical necessity is being bed confined, which carries a very specific set of definitions. A patient who is bed confined, by definition, cannot tolerate a wheelchair. If the EMS provider is documenting first hand that a patient is bed confined, then shouldn't the EMS provider be directly observing that the patient cannot tolerate a wheelchair? If the EMS provider is simply repeating what is reported by nursing home staff, then wouldn't the physician declaration of medical necessity be the primary proof of evidence since anything documented is hearsay? Additionally, shouldn't a test for bed confinement be done for every transport then, especially since PCS forms for routine scheduled transports are kept on file instead of generating a new one every transport? Finally, how many EMS providers are properly trained to determine medical necessity in contrast to just documenting it?



Well the other day I did a Dialysis A trip with the bls justification being "cannot tolerate a wheelchair due to generalized weakness" yet arrived on scene to find the pt unsupervised sitting upright aaox3 denying pain or illness in a wheelchair. At that point i can say that the pt can tolerate a wheelchair, so i cant really document that they cant.


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## truetiger (Jul 10, 2011)

Having 13 SNF's and residential care facilities in my district, I'm well aware of the discrepancies in the paperwork/story. Just document what you find. C/C is what the patient is complaining of, not a diagnosis. As for IFT's, I document why we were called, e.g. if we are called for a patient going to the city with chest pains and he is going for a cardiology consult I would document for my c/c ALS transfer for cardiology consult not chest pains. He is in the ER for the chest pains while he is in the back of my rig for the transfer.


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## Frozennoodle (Jul 10, 2011)

My opinion remains unchanged as well as the opposing side's.  Futility, meet brick wall.


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## canadianpcp (Jul 10, 2011)

I had a call the other night for a lady who contacted our dispatch and said she needed Adivan. So the call came across our CAD system as psychiatric pt. is requesting Adivan. When my partner and I arrived at the pts home first thing the pt. said was she was sorry and that she fell asleep and that she needed Adivan. I asked her why she called for an ambulance? Her response was " She needed Adivan". So on my PCR I put under Chief Complaint " Patient called cause she needed Adivan" 
Under my diagnoses at the bottome of my PCR I put the code down for psychiatric, but that was not her chief complaint.
As pointed out in above posts. You put down what your patients tells you as to why they called for an ambulance.


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## firetender (Jul 10, 2011)

*It doesn't have to make sense...*

...it only has to pay the bills.

Remember, we're embroiled in a Corporate-medico-legal complex where each element is dependent on another. For example, IFTs keep you and your truck on the road. As a result, bending rules is part of the game.

Sure, you're there to uphold some integrity in the delivery of medical care, but at the same time somewhat responsible that the whole boat stays afloat. From there on it's about picking your shots carefully because there are a lot more people on that boat than you.


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## Aerin-Sol (Jul 10, 2011)

As BLS IFT, 90% of my C/Cs are "none," because that's what the pt tells me.


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## akflightmedic (Jul 11, 2011)

n7lxi said:


> I don't understand why this is such a difficult concept for you to grasp. As an IFT EMT writing a PCR, it's important that the actual MEDICAL reason the patient requires a BLS ambulance be documented, not a chief complaint. Its really up to you and your service. You can write weakness or "patient can't tolerate a wheelchair" or whatever you want, but ask the billing department what the reimbursement rate is on Medicare billing and them ask how many are bumped due to improper documentation or lack of medical necessity.
> 
> Then hire an EMS consultant to teach a class to the line staff on reimbursable PCRs and see if that changes. If you've been through a workshop like this, the way you document routine BLS IFT calls will change. For the better.



I was doing well until you made it personal. I fully understand what you are trying to express so there is no lack of grasping on my behalf. It is also quite presumptuous of you to assume I have no knowledge of IFTs, how to document or how tough it is getting payments out of Medicare. BTDT as they say many times over.

My previous position stands as does the brick wall.


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## ffemt8978 (Jul 11, 2011)

Can somebody explain to me where it says that the chief complaint is the reason and justification for the transport?  Medical neccessity and chief complaint are not always the same thing.

Sent from my Android Tablet using Tapatalk


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## akflightmedic (Jul 11, 2011)

ffemt8978 said:


> Can somebody explain to me where it says that the chief complaint is the reason and justification for the transport?  Medical neccessity and chief complaint are not always the same thing.
> 
> Sent from my Android Tablet using Tapatalk



Agreed.

The medical necessity of it all will come when you document your physical assessment.


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## afro (Jul 12, 2011)

Aerin-Sol said:


> As BLS IFT, 90% of my C/Cs are "none," because that's what the pt tells me.



We have a winner here. You do not replace assessment skills with facility staff words. Ask them if anything is bothering them.

Just be sure to document a necessity in the narrative so you can get paid.


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## DrParasite (Jul 13, 2011)

Aerin-Sol said:


> As BLS IFT, 90% of my C/Cs are "none," because that's what the pt tells me.


Bingo.  back when I did IFTs, i had NONE all the time for the patient's CC.

Weakness is the CC for dialysis calls, if the patients says they are weak.  their diagnosis is ESRD.  there is a difference.

sadly, in the world of IFTs, most places will let you get away with murder, as long as 1) no one files a complaint against you 2) you don't get into a motor vehicle crash while on the ambulance and most importantly 3) your paperwork is filled out enough to ensure the company is able to successfully bill for the trip.


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## HotelCo (Jul 15, 2011)

Dialysis isn't a chief complaint, it's a procedure. 


Sent from my iPhone using Tapatalk


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