question on medical decision making and auditing

hello,
i am auditing a note from a NP working in a cardiologist office.

she states "The plan of care is in collaboration with a doctor"- when questioning the NP she states she worked in collaboration with a doctor in her group regarding a plan of treatment. she feels she should get credit for this under the categories of data to be reviewed-discussion of case with another health care provider.

my question: if this allowable, what does her documentation need to reflect?


thanks for the help
Tonya

Question on medical decision making and auditing

The documentation guidelines don't help you out much. The guidelines say "discussion of contradictory or unexpected test result with the physician who performed or interpreted the test is an indication of the complexity of data being reviewed."

All the audit tools I have include "discussion of case with another health care provider" and allow 2 points in chart B.

I hope your code is not hanging on this one element of MDM.

In your case if the patient has an unexpected result or presents with contradictory results and the NP collaborates with a doctor I would ask the NP to document the complexity of the case and how the collaboration assisted with the final plan of care.

Louise

It also depends on who is billing

If the NP is using their own NPI then collaboration could count; if the doc's NPI is used then he is "doing the work" so it does not count.

question on medical decision making and auditing

If they are in the same practice, I would not credit this. The Guidelines are explicit, but in my opinion, this would fall under supervision.

If she worked in a Family Practice, and called the Cardiologist, I would give credit.