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

[NomadicMedic]

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.

 

[JPINFV]

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?

 

[EMTswag]

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.

 

[truetiger]

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.

 

[Frozennoodle]

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

 

[canadianpcp]

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.

 

[firetender]

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.

 

[Aerin-Sol]

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

 

[akflightmedic]

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.

 

[ffemt8978]

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.

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[akflightmedic]

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.

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Agreed.

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

 

[afro]

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.

 

[DrParasite]

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.

 

[HotelCo]

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


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