Irritated about making an appt.

Nurses General Nursing

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Hi I wasnt sure where to post this! I have just about had it with the receptionist at the clinic. Whenever I call for an appt. she insists on knowing EXACTLY what I am coming in for. I feel that it is none of her business. I know they schedule all appts for 15 minutes, and then when they run into probs, that is why doc is late and appts get backed up!! I finally have resorted to saying " I am coming in to see my doc and will need 15 minutes" or 30 minutes ( whatever I feel I need). One phone answering gal said she needed to know just what the medical prob was because they were busyand maybe she could help!! I asked her what medical training she has had, well she was empl;oyed there for 3 years. Whoopde do. I told her if she absolutely needed to know she could feel free to read the chart after I was done with the doc!! Needless to say I really Pizzed her off. Oh well, just had to vent!!

Welcome to the board! :D It's a pretty supportive and fun place. :kiss

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Originally posted by Nurse2bee

Also I work as a cashier at night to pay the bills till I graduate. Me and the Korean guy I work with call ourselves peons all the time. We say the owner is the king and we are the peons. Sometimes you have to have a sense of humor about life. I think the whole window peon thing got a little out of control. Venting is venting and this sight is supposed to be for nurses right? It is called all nurses. I think that she was trying to inject a little humor and got ripped to shreds. I don`t see anyone objecting to the reply that mentioned the as#hole DRs. So apparently it`s ok to talk trash about Doctors, but not anyone else? Let`s be fair.

welcome to the board

calling onself a peon is okay, we all do it

being called a peon by a superior sucks, and is wrong

it perpetuates the stereotype that nurses eat their young...

and the a**hole comment to which you refer is taken out of context...my point was if a doc verbally spewed something similarly offensive to a nurse, then this board would be full of anti-doc posts (stick around...there's a lot od doc hating going on)

it's a good board, i usually only read posts, i only reply when it hits at home (i was labeled peon many, many times, and still am my some docs)

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Thanks for the welcome Kitty and Sean. Nurses don`t eat their young? Darn. Where`d that kid go anyway????heeheehee

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Hogan,

Sounds like you've been burned with the 'peon' thing before & that's why it bothers you so much, which is ok, but as the last few posts have said we're here to relax and vent. As a peon I agree! I'm sure no one here would want to disrespect the person to their face. BUT they do have valid gripes about a person trying to go out of their scope, so to speak ;)

This stuck out to me:

that a janitor, or "window peon" could keep anyone's confidence...

True, I'm sure they could, but they shouldn't be asked to or believe they should when it comes to med info, as I'm sure you know & a good peon also knows...and if they don't as some people have mentioned THAT is a problem!

Anyway, I COME IN PEACE!

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Specializes in Med-Surg.

Ahem, back to the original subject.......

RN2B2005, thanks for the view from the other side of the window, but I am a little confused.

You stated an initial ICD-9 code is assigned when appointment is made. I'm pretty sure this is this billing/ insurance code. Does this code get changed or revised after the actual physician diagnosis is made? Guess I'm not clear why this code is assigned prior to the visit. Can you add any more explanation for me?

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i can help on this subject...for our computer system, the appointment can't be accepted in the system unless a reason for being seen (chief complaint) is entered...This can and does change, based on the outcome of the visit...

other systems might differ, but generally speaking a basic chief complaint is initially listed to categorize (appt lenth, time of day, etc), and then gets more specific after the visit is completed...

for example: a chief complaint might be finger pain, then the resulting diagnosis is left index mc fx, s/p injury...quite different ICD9s and quite different reimbursements

sean

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Originally posted by eltrip

I'd love to hear the reaction to that one! Fortunately, I've not encountered that one. However, I frequently caution patients that when they call their Dr.'s office to ask to speak with either an LPN or an RN, & to not share their medical issues with whoever just happens to answer the phone. Educating patients...it's a good thing! ;)

This would be a great idea if the nurse (me) wans't busy doing everyting else in the office. I do not have time to answer EVERY persons phone call, I do however ask the receptionist to take a name and # so when time allows I call them back, if they insist on talking to the nurse.

Very seldome when someone isists on speaking w/ the nurse is it life threatening, nor something that could not be discussed w/ someone else. ex....when is my next appointment, i need a r/f on lasix, etc...

The phone IS MY ENEMY at work lol

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Does anyone know why in the heck my first post double-posted? It wasn't like that last night, and heck if I can delete it. Anyway...

You stated an initial ICD-9 code is assigned when appointment is made. I'm pretty sure this is this billing/ insurance code. Does this code get changed or revised after the actual physician diagnosis is made? Guess I'm not clear why this code is assigned prior to the visit. Can you add any more explanation for me?

Yup, it usually does change. If you're coming to see me for a diagnostic exam--an MRI, or ultrasound, or labwork, or whatever--we generally have an ICD-9/10 code assigned before you arrive; for other visits, a code is assigned about 80% of the time based on intake information.

For instance, if you call me and want to schedule an exam because you've been coughing for three weeks, then my Dx code for insurance purposes will be cough, unspecified. This code can change, but usually doesn't; the physician generally has a list of about 100 Dx codes that he or she picks from, on a pre-printed fee slip (usually a triplicate form attached to the front of your chart, with your name and insurance type in the upper left corner), and they don't generally get very creative.

The actual CPT (treatment) code is what pays the bills--and that is determined after you leave, by the physician or by someone like myself. The reason for assigning an ICD-9/10 code prior to the visit is mostly that most scheduling software works off algorithms based on the initially inputted code; that, and that when I call an insurance company to verify your benefits, the first question out of the nurse reviewer (yes, it's usually an RN I'm talking to) is "What ICD-9 are you assigning?"?

Physicians still have to actually verify and OK the final ICD code, but it's "window peons" like myself who do the legwork.

BTW, for everyone who thinks that non-degreed personnel don't understand patient confidentiality issues....our clinic routinely sees players from two major sports team here in the city. Last fall, one of the truly great players came in--a guy I would love to meet and get an autograph from. For TWO DAYS before he arrived, the NURSING and TECHNICAL staff, plus the doctors, were talking about why he was coming in, speculating about his career, etc. around the water cooler. The day he came in, WHILE HE WAS ON THE CT TABLE, a nurse-technologist--a licensed individual with a four-year degree in nursing and a second degree in radiology technology--asked him for his freakin' autograph. She saw absolutely NOTHING wrong with this and came tittering up to the front desk, along with our lead tech.

Guess what? None of the front desk staff talked about the player AT ALL. The nurse and the lead tech were later reprimanded--and we received gift certificates from our boss.

Turned out the player (a very nice guy) wrote a letter to the medical director detailing the autograph request and his discomfort at being 'on display' while in for a medical exam. Turned out also that in that letter, the player mentioned myself and the other receptionist on duty at time by name, stating that we were the ONLY professionally-mannered staff that morning (the doctor on duty also put in an autograph request), and that he appreciated our kindness and the fact that we didn't treat him differently.

He sent me a lovely baby gift later that week--I was seriously pregnant when he was seen, and we'd talked about children, his and mine. I did my job; when my husband saw the report on the news about the player's injury, my only comment was that he was a nice guy. Nothing else. Now when the team trainer calls to schedule an appointment for one of the players, he always asks for the front desk--he used to ask for the nurse technologist, but not since her little performance with the autograph that day.

So there you go. My guess is the reason that itsme's clinic can't keep good clerical staff is that they don't value them--and patient care suffers for it, so patients don't value clerical staff even when they're just doing their job.

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RN2B2005,

nice story :)

our software thankfully doesn't require an ICD9 upon check-in, just a general (narrative) description, and we manually code our billing sheets after the visit, so the data entry person/coder (window peon's cousin) must check the billed services against the chart (thus allowing him/her to see the chief complaint...oh no, another hole in the dyke, what are we to do...the next thing you know, the evening news knows about my hemorrhoids!):roll

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Yah, I keep the local news on speed dial...you know, so I can alert them whenever Mrs. Brown comes in with a new lump...Lord knows I've got nothing better to do, just sitting there at the window, being a peon...lol :rolleyes:

***NOTE FOR THE HUMOUR-IMPAIRED: THE ABOVE COMMENT IS MEANT IN A PURELY FACETIOUS VEIN!!***

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l'm horrified, l have never been asked by the docs receptionist why l want to see the doc.

First of all its none of their business, and what about the confidentiality act?

l just ring and ask for an appointment to see the doc and they give me a time without ever asking why l want to see him.

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Originally posted by leeca

l'm horrified, l have never been asked by the docs receptionist why l want to see the doc.

First of all its none of their business, and what about the confidentiality act?

l just ring and ask for an appointment to see the doc and they give me a time without ever asking why l want to see him.

that's how that doc chooses to run his business, and that's his business and his right...but please don't be horrified, the "receptionist" (probably the office manager, and an MA, and his billing person) will find out by end of business day...it's her business to do so (whether charting your vitals, doing the billing, or some other task related to the doc's patients)...think about it, she's not blind, deaf, and dumb...

really?? it never occurred to you that others in the office will know the nature of patients' business?? this has to be common knowledge, doesn't it??

They're just scheduling appointments haphazardly, without ANY knowledge of the chief complaint????

please, no offense or disbelief intented, I'm just trying to convey my flabbergastedness of that office's scheduling procedures...Every office I've ever worked, at least puts something down for a chief complaint over the phone...

Even my vet wants to know why I'm bringing my dog in!

sean

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