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I don't think it's "coaching" to tell someone that they have ordered a
test associated with a diagnosis that is not considered by Medicare to
be an appropriate indication for the test as long as you don't give them
a menu of what is "payable", on the contrary, it's education- we did
receive a legal opinion from our hospital in my last job that said
reading physicians could change the diagnosis if they got a better
history or observed something during the exam that supported the
alternative diagnosis- for example, your reading panel may want to ask
the legal folks in your shop if they can change diagnosis to 433.10 if
they see ANY atherosclerosis in a patient having a carotid duplex scan
for "dizziness"


Joseph R. Schneider, MD, PhD
Vascular and Interventional Program of Central DuPage Hospital
Ambulatory Services Pavilion Suite 201
25 North Winfield Road
Winfield, IL 60190
Voice 630-933-4487
Professor of Surgery, Northwestern University Medical School
 

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-----Original Message-----
From: UVM Flownet [mailto:[log in to unmask]] On Behalf Of Nancy
Hohn
Sent: Thursday, September 27, 2007 1:11 PM
To: [log in to unmask]
Subject: Physician Order Entry

For YEARS I have wanted to develop a chart basically stating if you
order Test X and want to get paid use Reason A, B, C, D...  However I
have been told by our coders that is considered "coaching" and
considered fraud by Medicare.  How is what you are doing different?
Nancy

-----Original Message-----
From: UVM Flownet [mailto:[log in to unmask]] On Behalf Of
Schneider, Joseph R.
Sent: Thursday, September 27, 2007 1:06 PM
To: [log in to unmask]
Subject: Re: : dvt = syncope


I used Epic EMR with CPOE (computerized physician order entry) for four
years including orders for vascular lab studies- our system did not
prevent people from ordering, for example, carotid duplex scans for
"dizziness", although one can configure these things to warn people that
ordered tests have been associated with "non-payable" diagnoses
(ICD-9-CM) codes and insist that ordering individuals acknowledge that
they know that the patient may get a bill- I am certain the Cerner
system can also be configured that way and frankly, it takes a little of
the heat off of the vascular lab physicians and techs since the ordering
physician is warned by the machine, not a human, and is also given a
pretty legitimate reason why they might want to come up with a different
diagnosis or, even better in the context of this thread, that perhaps
they have ordered an inappropriate test- I'm pretty sure that syncope is
not a payable diagnosis for either carotid duplex or venous (DVT) duplex
exams- I am sensitive to the need to keep our referring doctors happy,
but I don't think they blame me for Medicare's rules


Joseph R. Schneider, MD, PhD
Vascular and Interventional Program of Central DuPage Hospital
Ambulatory Services Pavilion Suite 201 25 North Winfield Road Winfield,
IL 60190 Voice 630-933-4487 Professor of Surgery, Northwestern
University Medical School
 

This message and any included attachments are intended only for the
addressee. The information contained in this message is confidential and
may constitute proprietary or non-public information under
international, federal, or state laws. Unauthorized forwarding,
printing, copying, distribution, or use of such information is strictly
prohibited and may be unlawful. If you are not the addressee, please
promptly delete this message and notify the sender of the delivery error
by e-mail. 

 

-----Original Message-----
From: UVM Flownet [mailto:[log in to unmask]] On Behalf Of Lisa
Mekenas
Sent: Wednesday, September 26, 2007 10:20 PM
To: [log in to unmask]
Subject: Re: : dvt = syncope

Sue/Elizabeth
You said that you recently started having the docs ordering their own
electronically. We are getting ready for that here--Cerner system --
They also have to pick a reason listed or can type in other. We
downloaded all the usual reasons for each exam but I forsee the "other"
being used. The docs aren't happy about having to sit on the computer to
"write orders" already and the training has only begun.  How's it
working for you? Any problems you see consistently that I could fix
now--we are still doing the final touches on the program. Lisa
-----Original Message-----
From: UVM Flownet [mailto:[log in to unmask]] On Behalf Of
Betty-Sue/Elizabeth

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