NurseValue’s blog has exceeded 3000 visits.  Whoop!  Whoop!  Thank you to our faithful followers.  We would like to meet your needs for good healthcare information for both our healthcare managers and healthcare consumers.  Please, feel free to let us know what you would like to see from us in the coming days.  Again, thank you!

How to Choose a Surgeon

When you have the opportunity to consider a surgical procedure, there are number of things to consider. First and foremost the best way to have the best surgical outcome is to avoid surgery entirely.  This option is not always possible, but it is important to explore all options before determining if surgery is the best option for your particular problem.  Obtaining a second opinion is something you may want to consider if you have the time.  Once that is determined that your surgery is necessary, the following suggestions may prove helpful in determining who you would like to be your surgeon.  Not all surgeons with wonderful personalities have the most skill in a particular surgery.  There is much more to consider!

·         Is the surgeon board certified and is his certification up to date?  This can be researched on http://www.abms.org

·         How often has your surgeon performed your type of surgery in the past year?  The purpose of this question is not to get the busiest surgeon in your area, but rather to choose a physician with experience in your type of surgery and not one who has never performed or rarely performed your particular surgery.

·         Not all surgeons will answer this question, but many of the good ones will—What is your success, failure or complication rates with this type of surgery?

·         Where does your surgeon plan on performing the surgery?   There are now a number of websites that provide infection rates for particular hospitals. You may access this information at

http://www.consumerreportshealth.org.  On the landing page put in Hospital and you will be taken to a page that will allow you to research hospital infection rates.  This web site provides a lot of different type of health ratings/evaluations that may prove helpful.

·         Is the surgeon and the hospital he is affiliated covered by your health plan? 

·         Does the hospital that you and your surgeon are considering follow best healthcare practices?  Luckily there are a number of hospital comparisons done by Medicare.  You can access this information at www.hospitalcompare.hhs.gov.   Put in the area code of the hospital you are considering and you will be provided with the hospitals within that zip code so you can compare the findings at each hospital. 

Prepare for the inevitable Health Emergency-Part III

We have identified several websites that will provide you additional information regarding future healthcare directives when you are unable to make decisions for yourself. 

             ·         https://www.nia.nih.gov/health/publication/advance-care-planning

 ·         http://www.americanbar.org/groups/real_property_trust_estate/resources/estate_

        planning/living_wills_health_care_proxies_advance_health_care_directives.html

·         http://mayoclinichealthsystem.org/locations/mankato/for-patients/advance-care-planning/create-your-advance-directive

     ·         https://www.justia.com/estate-planning/wills/living-wills-advanced-health-care-directives/

Prepare for the inevitable Health Emergency-Part II

 

When a major health issue arises there is often no time to prepare. It leaves us vulnerable to the decisions of others.  We can prepare for these times by discussing our wishes with at least two of our loved ones.  The reason I recommend two individuals be made aware of your wishes is that there is a possibility that you will be with one of these individuals who may also require emergency services and not be able to give directives for you. 

 

 

Below are some of the activities which will help to ensure your wishes are followed:

·         Think about your healthcare wishes carefully to determine exactly what you do and don’t want done if you are in a serious health situation

·         Choose your two representatives carefully and involve them in your plans; the person(s) you choose will be responsible for making decisions about your healthcare.  It is advisable that you choose one primary person and name a secondary person if the primary person is not available.

·         Discuss your wishes with your loved ones and your representatives

·         Obtain a “Healthcare Power of Attorney” form.  This form is often specific to the state in which you live in.  If you google healthcare power of attorney form for your state you will find a number of sites with this form.  Additionally, this form is often available at your Doctor’s office or your local hospital.  You just have to ask.  I suggest that you get 2 forms so you have one to plan on and the second to act as your final copy.

·         Fill out this form and remember that although each section has specific instructions, you may cross out a section you don’t agree with and write your precise desires.

·         Once the form is completed it is recommended that you sign it and date the form in front of a public notary.  Many banks have a notary and the services are often free or require a nominal fee.

·         Once the form is completed and notarized, keep a copy in a safe place in your home and/or in your bank box. Provide a copy to your attorney and a copy to your primary provider.  Also provide a copy of this form to both of your chosen representatives. 

·         Advise your representatives to keep this form in a safe place as they may need to provide it to the hospital or facility that you are admitted to.  This form is then kept in your medical file for the duration of your hospital or facility (i.e.:  nursing home or rehabilitation facility) stay.

It is important to note the difference between the Healthcare Power of Attorney and a Living Will.  The Living Will is limited to your deathbed concerns only.  It is used to declare your desire to or not to have life prolonging measures when there is no hope of recovery.  The Durable Power of Attorney for Healthcare covers all health care decisions and is active only when you are incapable of making decisions for yourself.  You can, however direct your healthcare power of attorney designee(s) how you would like them to act in regards to your deathbed issues within the scope of your Healthcare Power of Attorney. You may want both forms as the Living Will generally covers the do not resuscitate directives but does not deal with important medical concerns you may have leading up to this point in time.  Some facilities and hospitals may accept the forms you have written, but may also require their own specific forms during an inpatient stay. 

This is the second article concerning Healthcare delegation.  The first one was very general identifying the actions you may want to consider.  The next post will lay out some links on the internet that may provide you with additional resources and ideas regarding you plans for your future healthcare management.

Coding for Imaging Services

In most cases imaging services are split into technical and professional components.  A modifier for the technical component is added to the 5 digit CPT code (copyright per AMA).  The abbreviation for the technical component is TC and the abbreviation for the professional component is PC. 

The PC of an imaging service is for the physician’s work interpreting a diagnostic test or performing a procedure.  The modifier for PC is 26.  Depending upon the provider pricing guidelines the PC or the 26 may be added to the 5 digit CPT code to communicate that the pricing is for the physician’s portion of the imaging. (I.e. 71010-26 or 71010-TC)

The TC of an imaging service is for the non-physician work.  This portion of the imaging includes the administrative, personnel, equipment and equipment cost related to the testing.  Depending upon the provider guidelines the TC or 27 is added to the 5 digit CPT code.

Generally speaking the charge for the technical component is higher than the charge for the professional component.  However, the cost of the professional plus the cost for the technical component is not larger than the charge for the global service.  The global code is the 5 digit CPT code without modifiers.  Without modifiers appended to the CPT code it describes an imaging service in which the same billing entity provided both the professional and technical component of the service.  An example of this would be a chest x-ray that was done in the MD office and the MD in that office read the x-ray. 

Now, if this is not enough to think about, it should be noted that not all imaging services can be distinctly split into a professional and technical component.  Examples of these types of services would be the interventional radiology services (CPT codes 77401-77416).  These codes are billed as global services.

When reviewing the charges for imaging services it is important to determine if the charges are for the TC, the PC or are global. This ensures the appropriate assessment of the billing for the imaging service(s) provided.  This is not always a straight forward process.  Often there are two separate providers with two separate bills that are issued without the modifier to identify the partial service provided.  The appropriate billing price must be assessed relying on the place of service and the type of provider entity.

Prepare for the inevitable Health Emergency-Part I

The first thing that most of us think about when estate planning is a will.  There are other decisions and forms to think about.  In the upcoming posts we will discuss the living will and the Healthcare Power of Attorney. These two forms provide you with a voice for your healthcare should you not be able to speak for yourself.

Celebration of Veterans everywhere--Every day is Veterans day

I

Source: Acuity-Insurance-flagpole; source Wikipedia

Thank you for all the men and women who have served, are serving and will serve.  NurseValue recognizes your commitment, service and sacrifices.  Thank you for allowing us to be free and live in a country of opportunity.

NurseValue is proud to announce our newest certified case manager,  Cortney Hubbard, RN, CCM.  Cortney joined us in 2010.  She has been a very busy since that time.  Cortney became a certified professional coder (CPM) and then went on to complete nursing school and obtained her RN licensure.  She has done so much in the last 5 years while continuing to be an asset not only to NurseValue but to every client she works with.  Please join us in celebrating Cortney's long list of accomplishments!

I am excited to be part of the new second edition of the Path to Legal Nurse Consulting. I provided one of the chapters.

Wherever you are on the path to legal nurse consulting career, you will benefit from these inspiring stories from successful LNCs. In this new second edition, Patricia Iyer tapped the expertise of her colleagues to bring you wit, wisdom, and lessons learned. The 42 chapters include updated chapters as well as 16 brand new chapters written by legal nurse consultants who are independents, expert witnesses and in-house consultants. The book is chock full of advice, encouragement, and humor.

Get your copy of this book at a special prepublication price of $20. Order at this link to get this price: www.legalnursebusiness.com/Path.