Q&A: Be wary of over reliance on nurse practitioners for documentation
Q: We are getting pressure from our othopods to send all queries to their nurse practitioner (NP). Our facility bylaws allow NPs to function independently and they are allowed to answer queries without co-signature, so we routinely send queries to NPs who are caring for patients and we have great success with them.
The difference here is that the orthopods want us to send all queries to their NP, even if he/she is not caring for the patient. The ACDIS/AHIMA query guidelines tell us to query the provider that documented whatever needs clarification (though because we have a team approach with hospitalists, we often query the attending caring for the patient now, not necessarily the documenting provider). Our coding department has said they will not accept query responses from a non-treating provider. What do you think?
A: I have seen this happen at a number of facilities. They are using the NP/PA to do the “dirty work.” There are varying opinions on this:
- NP will become very good at documentation and become your best friend
- Queries will get answered in a timely manner
- If they are going to respond to queries they must see the patient. If not, they are a potential liability for the medical group and hospital.
I also wanted to respond to the group regarding who/where you can obtain documentation from:
- Pathology = no
- Echo = no
- Radiologist = no (however, CDI/coding can pull the specific fracture site and/or vessel sites directly from reports as long as the diagnosis is stated in the H & P/PN/Consult/ER, etc.
- EKG = no
- Cath report = yes
However, remember that in a query you can “refer” to that information.
Editor’s note: Deanne Wilk, BSN, RN, CCS, CDI Manager at Penn State Health in Hershey answered this question. Make sure to work with your facility compliance and coding departments in incorporating any recommendations as advice provided is general in nature.