Documentation of EKG in ED for reimbursement purposes

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Hey folks,

Quick question - we've been told that the RN or the ED tech MUST document the EkG was done for reimbursement. Documenting it has been done makes total sense...however that the RN or ED tech must be the ones to do it, does not. The ER physician's interpretation is always in the chart...wouldn't this indicate the EKG was done? We are being told that even though the ER physician has documented the EKG, if the nurse or tech hasn't documented it was done, then per CMS we can not collect.

I have searched for this reg everywhere....can anyone help me find this, or find something to support that it doesn't have to be the nurse or ED tech?

Thanks much!:yes:

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Specializes in Emergency & Trauma/Adult ICU.

Yes - either electronically or on paper, there must be some evidence that it was ordered, and that it was performed.

Issues like this make apparent the byzantine world of chart review / coding. Not a job I would want ...

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Altra,

Thank you for your reply. Just to clarify...if the electronic chart reflects the EKG was in fact ordered, and the ER physician has documented his interpretation of the EKG under the heading "EKG interpretation" would that not in fact satify the reg? I'm not understanding why it has to be documented by the nurse or ED tech as actually done, when it's been documented as reviewed by the ER doc and therefore had to have been done. There are many many days I think I should do chart reviews for coding as part time job...just because I can see the obvious....

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If it is not written down/charted as being done, it was not done.

You have the order written to do it, you have the documentation that the MD reviewed it, but what did they review? What EKG? None was ever done according to the chart.

See the gap in charting? You must have all 3 steps for it to be valid.You take any one of these steps out and it is not valid.

We all know if one was ordered and the MD reviews it and signs off it was done, but legally and chart wise, it was not.

Now as for who has to chart it was done, that is a facility thing. Where I work if you have access to that area on a chart (all electronic) you can document it, so the MD, PA/NP, RN, tech or even secretary can chart it being done (but is pretty much always done by either the RN or tech).

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And stupid stuff like this is why nurses want to leave the profession. It's a small thing but this silly stuff adds up over the course of a shift. The doctor can not review an EKG that was not done.... but I understand...... I'm assuming its a safety issue. Did the doctor review the correct EKG bc according to the chart an EKG was ordered but never done.......

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My hospital that uses EPIC is now retraining RN's/Tech's to document in certain areas of the chart to collect revenue.... And yes, we have to check a box that the EKG was done so the bean counters can collect and charge for it...

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My hospital that uses EPIC is now retraining RN's/Tech's to document in certain areas of the chart to collect revenue.... And yes, we have to check a box that the EKG was done so the bean counters can collect and charge for it...

How much do you like your job? Healthcare is a business. If you don't like to work for money, try to live off of a volunteer job.

And stupid stuff like this is why nurses want to leave the profession. It's a small thing but this silly stuff adds up over the course of a shift. The doctor can not review an EKG that was not done.... but I understand...... I'm assuming its a safety issue. Did the doctor review the correct EKG bc according to the chart an EKG was ordered but never done.......

And stupid stuff like your statement is why hospitals don't get reimbursed and why JCAHO/CMS slams you.

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Oy. I just laugh at the double edge sword. I went many years without insurance. The way they charge for things but I get it. They have to cover costs for no insurance, paying wages for multiple interdisciplinary team members.

It's a quality measure too. If you document it was done, it was done. How many times do they get lost? Happens a lot.

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I think it has to do with billing , since the tech or ER Nurse are the ones actualy DOING the ECG physically they have to do the charting for it. We have to do the same thing (We dont even have techs to do them for us).

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How much do you like your job? Healthcare is a business. If you don't like to work for money, try to live off of a volunteer job.

And stupid stuff like your statement is why hospitals don't get reimbursed and why JCAHO/CMS slams you.

No, stupid stuff like understaffing, high ratios, being pulled in so many different directions, saturated work load, unsafe assignments, supervisors&etc that can't manage a patient load under the same working conditions but want to implement new protocols/policies that put even more stress on the nurse is the reason why hospitals don't get reimbursed and jcacho/CMS slams departments...

You can only Be so thorough with your charting before u began to neglect the very reason you are charting in the first place. There's a patient in the midst. Can a WORKING BEDSIDE NURSE ACTUALLY HAVE THE POWER TO SHUTDOWN some of this foolishness?

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I'm about to go get a drink.... My nerves bad just thinking about some of the silliness this morning... (sigh)

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Specializes in Emergency, Telemetry, Transplant.

Every EKG we do needs a doctor's order. Basically every chest pain gets an EKG before the doc actually writes the order--but, eventually the order does need to be there. As far as documenting the EKG to get paid--once the EKG is done, it is recorded in the computer than an EKG was done a such and such time on a given pt--again though, their must be an order.

We also document in the EMR "EKG done and shown to Dr. Smith." This is not written in the chart for reimbursement purposes, but rather for CYA--that way it is charted that the EKG (normal or abnormal) was done and given to a doc...not put away with the pt's paper chart (which now in the world of computerized charting, is basically just a face sheet)--just in case their is a subtle abnormality not picked up by the machine's computer.

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