Our practice has been doing Interventional Radiology for our hospital system for two years. We are seeking someone (consultant or otherwise) to help us identify things that from a clinical and coding perspective we may not be documenting and billing for appropriately. Our RCM has indicated that they can help translate the dictation into optimum coding (which they already do), but what we need more is to know that in order to perform Procedure X, an additional Procedure Y is a necessary step in that process, and needs to be documented so that it can be coded for appropriately.
Basically, from a clinical perspective - are we performing these procedures and documenting them optimally?
Anecdotally, our Anesthesia group has observed vascular surgeons performing similar procedures to IRs, and have noted that the vascular surgeons makes more extensive notes to himself and the nurse in the room with regards to what he is actually DOING than the IRs typically do for the same procedures.
Anyone know of a good source for this sort of consultation?
Thanks,
Tabitha
------------------------------
Tabitha Abraham
tabraham@bpadocs.comExecutive Administrator
Brevard Physician Associates
Melbourne FL
321-837-3820
------------------------------