Irritated about making an appt. - page 5

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... Read More

  1. by   boggle
    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?
  2. by   hogan4736
    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

  3. by   melsay
    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'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
  4. by   RN2B2005
    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.
  5. by   hogan4736

    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
  6. by   RN2B2005
    Yah, I keep the local news on speed 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

  7. 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.
  8. by   hogan4736
    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'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!

    Last edit by hogan4736 on Feb 26, '03
  9. by   Agnus
    Some times things are too complicated to just give the scheduler a reason. She should respect that I may not want to discuss it with anyone than the Doc.
    Some things are too personal.
    I may need to see him about something that never appears ever on the chart. It is between me and the Doc. This happens more than many would susupect. It truly is None of anyone's business and this possibility needs to be considered with every appointment.
    The paractice belongs to the MD no one else. He hires you to do certain things but there will sometimes be aspects of his business or practice that you are not privy to inspite of the fact that you may know more about him than his wife.
    Last edit by Agnus on Mar 1, '03
  10. by   hogan4736
    things discussed NOT subsequently put on the chart????
    and you're telling me that he can afford to outsource every office function (billing, chart review,etc), and no one in the office knows anything??? sounds hard to believe, and awful expensive for the practice..

    also sounds risky to me...every doc/pa/np/rn will smartly chart everything that was discussed, to protect the patient and the provider...

    that's just me and my quirkiness about wanting to keep my nursing license...

    let's say you discussed a reportable (to the state health dept) STD, and it wasn't charted...not charted means not reported...

    or let's say you were too embarassed to discuss constipation w/ the front office staff, and then "secretly" discussed it w/ the doc; and you convinced him not to chart that. 6 months later you find you have prostate cancer, and your previous constipation conversation/recommendations weren't charted...that could spell trouble...maybe far-fetched, or a bad example, but you get the point.
    But I implore you, everything done by or discussed w/ the doc, should be documented.

    Last edit by hogan4736 on Feb 26, '03
  11. by   kids
    All of this makes me really thankful for the system used at my PCP's clinic. When you call for an appointment the first thing you are asked if you are a new or established patient, the next question is do you feel you need to be seen urgently or is this appointment for a latter date. Depending on your answer established patients are transferred to the specific Doc's triage nurse or nurse coordinator, she gathers the info on why you need the appointment then hands you back to the scheduler after telling them how soon you need to be seen and for how long. At that point scheduler collects your insurance info and makes the appointment. This is at a 115 provider multi-specialty clinic.

    I have picked up a couple of statements made in this thread that I find very disturbing. I am surprised no one else has mentioned them:

    Originally posted by RN2B2005 (post #38)
    ...When the receptionist asked you what was going on, she was likely looking for something--a definitive symptom, like chest or abdominal pain--that would allow her to override her schedule or reschedule another patient and get you in to see the doctor that day....
    I have a hard time accepting that a Physicians off would accept the liability on a person without medical training (and it would be outside scope of practice of a student nurse) triaging patients and determining the level of urgency for an appointment.

    Originally posted by hogan4736 (post #33)
    ...the janitor often translates ALL of the history in EVERY ER in Phoenix...
    I also have a hard time believing this, in a private hospital maybe but state/federally funded hospitals are REQUIRED to provide translators for free. The *only* hospital (400+ bed) in my county has 24/7 in house Spanish & Russian translators.

    Originally posted by hogan4736 (post #41) ...Many people will see your chief complaint (including the janitor, who in our clinic, will be translating EVERYTHING)...
    Sorry but I feel your clinic is doing a huge disservice to the patients it serves. I feel your clinic has a duty to the community is serves to employ medical staff who speak the language. Given the high percentage of non-English speaking members in the community how can it be that none of them have any medical training.

    While the "need to know" may extend to receptionists, schedulers, medical records etc by NO stretch of the imagination does it extend to a janitor.
    Last edit by kids on Feb 26, '03
  12. by   hogan4736

    I have worked in 4 ERs in Phoenix, and all of them use other family members,other patient's family members, janitors, or anyone they can find. Honest to god's truth.

    We have one state hospital, I haven't ever worked there, so I can't speak to what they do, but I have my suspicions...All of the rest of our 14+ hospitals are privately owned... Over my last 8 years in the ER, I would go on record saying that the housekeeping staff do the lionshare of the translating...

    A couple of points related to this:

    1) oftentimes there are 1 or 2 staff that speak Spanish in the ED, but are extremely busy, so the doc grabs the housekeeper (we have a 24/7 dedicated housekeeper for the ED)

    2) sometimes only one nurse/cna in the whole hospital speaks Spanish, and will go to other floors to help translate, if available.

    3) This is likely to make me unpopular, and is slightly off topic, but if I MOVED to Germany, wouldn't it be arrogant of me to EXPECT that the hospital to have a 24/7 English speaker to translate...How is it the hospital's responsibility to translate for someone who has lived in the USA for 20+ years....And before you think I'm exaggerating, DAILY I encounter someone who has lived in Phoenix for 10-20 years and "me no speaka tha english"
    I'll argue that it's the families' responsibility to bring someone in that speaks good English to translate (think about some of the points that have been made on this thread, a 3rd party translator is someone else knowing your buisiness!! )

    4) many families prefer using their EIGHT year old to translate complicated (or embarassing) medical histories...

    oh, and to your first point about MA's possibly doing triage over the phone...I agree w/ you, but it goes on in offices all over Phoenix...For that matter, I know of several MA's giving IM Rocephin and other Abx, placing Foleys, etc...

    Last edit by hogan4736 on Feb 26, '03
  13. by   kids
    I have no problem an MA doing triage with supervision, or the invasive procedure you mention, as it is incorproated in their 1 year of training here in WA. I have reread RN2B2005's post and at do not see where she indicates she is an MA, she does however offer her perspective from "5 years of medical reception" (if I have overlooked her mention of being an MA I do apologize and would appreciate being directed to the staement).

    Any hospital that accepts Medicaid or Medicare funds are subject to State and federal rules, even if they are privately owned:

    an excerpt, copied and pasted from the 3rd link:

    [FONT=century gothic]The lack of language assistance capability among provider agency employees has especially adverse consequences in the area of professional staff services, such as health services. Doctors, nurses, social workers, psychologists, and other professionals provide vitally important services whose very nature requires the establishment of a close relationship with the client or patient that is based on empathy, confidence and mutual trust. Such intimate personal relationships depend heavily on the free flow of communication between professional and client. This essential exchange of information is difficult when the two parties involved speak different languages; it may be impeded further by the presence of an unqualified third person who attempts to serve as an interpreter.

    Some health and social service providers have sought to bridge the language gap by encouraging language minority clients to provide their own interpreters as an alternative to the agency's use of qualified bilingual employees or interpreters. Persons of limited English proficiency must sometimes rely on their minor children to interpret for them during visits to a health or social service facility. Alternatively, these clients may be required to call upon neighbors or even strangers they encounter at the provider's office to act as interpreters or translators.

    These practices have severe drawbacks and may violate Title VI of the Civil Rights Act of 1964. In each case, the impediments to effective communication and adequate service are formidable. The client's untrained "interpreter" is often unable to understand the concepts or official terminology he or she is being asked to interpret or translate. Even if the interpreter possesses the necessary language and comprehension skills, his or her mere presence may obstruct the flow of confidential information to the provider. This is because the client would naturally be reluctant to disclose or discuss intimate details of personal and family life in front of the client's child or a complete stranger who has no formal training or obligation to observe confidentiality.

    When these types of circumstances are encountered, the level and quality of health and social services available to persons of limited English proficiency stand in stark conflict to Title VI's promise of equal access to federally assisted programs and activities.Services denied, delayed or provided under adverse circumstances have serious and sometimes life threatening consequences for an LEP person and generally will constitute discrimination on the basis of national origin, in violation of Title VI. Accommodation of these language differences through the provision of effective language assistance will promote compliance with Title VI. Moreover, by ensuring accurate client histories, better understanding of exit and discharge instructions, and better assurances of informed consent, providers will better protect themselves against tort liability, malpractice lawsuits, and charges of negligence.