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TF1 Self-instructional Module for Coding Emergency Physician Services
Research Forum Abstracts
TF1
Self-instructional Module for Coding Emergency Physician Services
Brown JM/Texas Tech University HSC El Paso, El Paso, TX
Introduction: Documentation is an important and pervasive aspect of physicians’ work - about two encounters per clinical hour, for life. Reimbursement is one of the key purposes for which documentation is used. To produce excellent documentation for reimbursement, physicians require an understanding of the coding process. Coding lectures are ineffective, often focusing solely on counting elements. Little attention is given to diagnosis coding and the medical necessity determination. Few physicians have access to code books and fewer know how to use them. Coding is like any other procedure, requiring hands-on practice and a fundamental understanding of underlying principles. The Coding Module provides everything the learner needs to code ten encounters: definitions, principles, a step-by-step explanation of the coding process, a completed example, all codes and descriptors used in the module, a scoring sheet and answer sheet. The module was developed for use by senior ED residents. However, the module can be used by other learners at any level - medical students, residents from other specialties, EM faculty - and can be completed at any time during residency. Study Objectives: In completing the coding module, learners will: 1) assign procedure codes to ED services using CPT principles and the 1995 CMS Documentation Guidelines for Evaluation and Management Services; 2) Define “medical necessity” as understood by third party payers; 3) Based on the ICD-10-CM Official Guidelines for Coding and Reporting, assign diagnosis codes which describe the patient’s illnesses/injuries and support the medical necessity of services provided; 4) assess their work by comparing their answers with the actual codes reported. Methods: The module introduces the subject with a humorous anecdote motivating learners to proceed. Learners then proceed to the Coding Primer, which introduces the 1995 CMS Documentation Guidelines for Evaluation and Management Services, CPT, ICD, and medical necessity. Using their newly acquired knowledge, learners will code ten actual encounters, selecting codes from the tables provided. A worksheet is provided to assist with systematic counting of elements. Upon completion, learners self-assess using an answer sheet with explanations regarding the element count and other factors influencing the codes assigned. Conclusion: Coding is a skill developed by practice, based on an understanding of CPT, ICD, and CMS principles and guidelines. The coding module integrates principles, practice, and self-assessment into one convenient exercise. Physicians completing this exercise will acquire knowledge and skills which they can apply daily during their entire careers.
TF2
Development and Deployment of a Scribe Curriculum in a Busy Level 1 Trauma Center Emergency Medicine Residency Program
Ramirez R/UCSF Fresno, Fresno, CA
Introduction: Emergency physicians encounter expanding demands on a consistent basis. Although emergency medicine (EM) can be exciting and rewarding, it can also be taxing in which >65% of emergency physicians report burnout. Fatigue & length of shifts strongly correlate with burnout. Emergency departments (EDs) are increasing the use of electronic health records which take about 63.5% longer versus paper charting to complete. Use of voice recognition has not been shown to be superior to typed data entry. Scribes have been used to document important works throughout history and trends seem as though more EDs are utilizing them to aid with overextended workloads. Scribes have been shown to decrease the amount of time for documenting by about 36%, including a 30% increase in time allowed for direct patient care by emergency physicians. Scribe programs are operated via commercial companies for a premium or implemented by individual EDs resulting in less overhead costs. My objective was to develop and deploy a successful scribe curriculum within our institution. Objectives: Scribes were primary intended learners who were expected to 1) Undergo HIPPA training; 2) Demonstrate basic medical terminology proficiency; 3) Improve provider’s efficiency and productivity; 4) Be familiar with basic lab/imaging studies & common procedures; 5) Demonstrate quality charting; 6) Undergo basic research training. Methods: Hired scribes were college students who demonstrated potential in pursuing a medical career. Various strategies were utilized to facilitate training. Webbased flashcard-like modules facilitated memorization of key medical terminology, medications and commonly used abbreviations after establishment of an initial baseline score. Evaluation mandated >98% score to pass and scribes were also required to obtain a certificate in medical terminology via an online medical school course. Small group sessions and participation in resident lectures facilitated basic understanding of select
Volume 68, no. 4s : October 2016
disease processes. Supplemental handouts served as reference to aid with documentation requirements. Readings from select textbooks and proctored shifts taught scribes how to write eloquent patient histories and accurately record charting elements. Hands-on experience and participation with simulation sessions during intern boot camp helped scribes to become familiar with commonly encountered procedures and management of critical/advanced cardiac and trauma life support cases. Scribe performance is constantly evaluated via chart audits and provider evaluations. Scribes received basic research training via the collaborative institutional training initiative through the University of Miami to enroll patients in department research studies. Conclusion: Providers quickly appreciated use of scribes as shown by a Likert scale survey at the end of the first six months of the program. Scribes were felt to increase provider well-being, billing, efficiency, number of patients seen per shift and decreased the amount of charting time. The demands of emergency physicians can be exhausting. Scribes have been shown to decrease the amount of time required for documentation likely improving physician well-being and decreasing burnout. A scribe program can be easily manufactured by utilizing instructional modalities already known and experienced by physicians.
TF3
Sono Buff, an Online Multimedia Point of-Care Sonography Training Instrument Designed for Medical Students, Resident Physicians, and Emergency Medicine Faculty
Hafez NM/Rush University Medical Center, Chicago, IL
Point-of-care sonography (POCS) has become a daily tool in the emergency physician’s arsenal of diagnostic modalities (Moore and Copel 2011). ACEP endorses a wide spectrum of bedside ultrasound studies that it believes to be within the normal scope of practice for emergency physicians (2). CORD felt so strongly about the need for future emergency physicians to be trained in point-of-care sonography that it made ultrasound a mandatory part of residency training (Lewiss RE et al. 2013). In addition to aiding in the daily treatment of patients, POCS has also been shown to have medical legal benefits as well (Stolz L et al. 2015). Despite all of these benefits, training in POCS lacks standardization among medical students, resident and attending physicians. Sono Buff is an online multimedia POCS training program designed to allow asynchronous teaching of the critical basics of emergency ultrasound. The goal of the Sono Buff training program is for the learner to demonstrate his/her ability to recognize common critical images in emergency POCS and identify pathology on these images. Subsequently the learner should be able to obtain and analyze these images on their own. Sono Buff was primarily designed to give the learner the opportunity to attain basic critical skills in POCS prior to attending hands on training courses provided by ultrasound-trained faculty. There are five parts to the program. All components are multimedia slide shows created on the Articulate Story Line II software. The modules focus on knobology/terminology, E-FAST exam, aorta/IVC imaging, basic cardiac imaging and ultrasound-guided vascular access. The evaluation instrument is a series of six questions that will follow an ascending order of Bloom’s taxonomy. This formative evaluation instrument will assess the learner’s ability to recognize normal point-of-care ultrasound images, identify pathology on these images and subsequently demonstrate how they would be able to obtain/analyze these images. POCS is a vital skill set for anyone who provides care to patients in an emergency department. It is recommended by ACEP and CORD and has been shown to increase patient safety, decrease time to disposition, as well as to be medically legally protective. POCS requires hands on instruction; however, classes are often composed of learners who have markedly different levels of understanding when it comes to their knowledge of the critical basics. Sono Buff is an online multimedia learning tool that allows the learner to acquire these basics asynchronously and at their own pace. The addition of this module to hands on instruction will ensure that the limited available instructor time can be focused on an audience with an equal baseline understanding of the subject matter. References: 1)Moore CL, Copel JA. 2011. Point-Of-care ultrasonography. N Engl J Med. 364(8):749-57. 2)American College of Emergency Physicians. ACEP Emergency ultrasound guidelines-2001. Ann Emerg Med. 38(4):470-81. 3) Lewiss RE, Pearl M, Nomura JT, Baty G, Bengiamin R, Dupery K, Stone M, Theodoro D, Akhtar S. 2013. CORD-AEUS: consensus document for the emergency ultrasound milestone project. Acad Emerg Med. 20(7):740-5. 4)Stoltz L, O’Brien KM, Miller ML, Winters-Brown ND, Blaivas M, Adhikari S. 2015. A review of lawsuits related to point-of-care emergency ultrasound applications. West J Emerg Med. 16(1):1-4.
Annals of Emergency Medicine S151
TF1
Self-instructional Module for Coding Emergency Physician Services
Brown JM/Texas Tech University HSC El Paso, El Paso, TX
Introduction: Documentation is an important and pervasive aspect of physicians’ work - about two encounters per clinical hour, for life. Reimbursement is one of the key purposes for which documentation is used. To produce excellent documentation for reimbursement, physicians require an understanding of the coding process. Coding lectures are ineffective, often focusing solely on counting elements. Little attention is given to diagnosis coding and the medical necessity determination. Few physicians have access to code books and fewer know how to use them. Coding is like any other procedure, requiring hands-on practice and a fundamental understanding of underlying principles. The Coding Module provides everything the learner needs to code ten encounters: definitions, principles, a step-by-step explanation of the coding process, a completed example, all codes and descriptors used in the module, a scoring sheet and answer sheet. The module was developed for use by senior ED residents. However, the module can be used by other learners at any level - medical students, residents from other specialties, EM faculty - and can be completed at any time during residency. Study Objectives: In completing the coding module, learners will: 1) assign procedure codes to ED services using CPT principles and the 1995 CMS Documentation Guidelines for Evaluation and Management Services; 2) Define “medical necessity” as understood by third party payers; 3) Based on the ICD-10-CM Official Guidelines for Coding and Reporting, assign diagnosis codes which describe the patient’s illnesses/injuries and support the medical necessity of services provided; 4) assess their work by comparing their answers with the actual codes reported. Methods: The module introduces the subject with a humorous anecdote motivating learners to proceed. Learners then proceed to the Coding Primer, which introduces the 1995 CMS Documentation Guidelines for Evaluation and Management Services, CPT, ICD, and medical necessity. Using their newly acquired knowledge, learners will code ten actual encounters, selecting codes from the tables provided. A worksheet is provided to assist with systematic counting of elements. Upon completion, learners self-assess using an answer sheet with explanations regarding the element count and other factors influencing the codes assigned. Conclusion: Coding is a skill developed by practice, based on an understanding of CPT, ICD, and CMS principles and guidelines. The coding module integrates principles, practice, and self-assessment into one convenient exercise. Physicians completing this exercise will acquire knowledge and skills which they can apply daily during their entire careers.
TF2
Development and Deployment of a Scribe Curriculum in a Busy Level 1 Trauma Center Emergency Medicine Residency Program
Ramirez R/UCSF Fresno, Fresno, CA
Introduction: Emergency physicians encounter expanding demands on a consistent basis. Although emergency medicine (EM) can be exciting and rewarding, it can also be taxing in which >65% of emergency physicians report burnout. Fatigue & length of shifts strongly correlate with burnout. Emergency departments (EDs) are increasing the use of electronic health records which take about 63.5% longer versus paper charting to complete. Use of voice recognition has not been shown to be superior to typed data entry. Scribes have been used to document important works throughout history and trends seem as though more EDs are utilizing them to aid with overextended workloads. Scribes have been shown to decrease the amount of time for documenting by about 36%, including a 30% increase in time allowed for direct patient care by emergency physicians. Scribe programs are operated via commercial companies for a premium or implemented by individual EDs resulting in less overhead costs. My objective was to develop and deploy a successful scribe curriculum within our institution. Objectives: Scribes were primary intended learners who were expected to 1) Undergo HIPPA training; 2) Demonstrate basic medical terminology proficiency; 3) Improve provider’s efficiency and productivity; 4) Be familiar with basic lab/imaging studies & common procedures; 5) Demonstrate quality charting; 6) Undergo basic research training. Methods: Hired scribes were college students who demonstrated potential in pursuing a medical career. Various strategies were utilized to facilitate training. Webbased flashcard-like modules facilitated memorization of key medical terminology, medications and commonly used abbreviations after establishment of an initial baseline score. Evaluation mandated >98% score to pass and scribes were also required to obtain a certificate in medical terminology via an online medical school course. Small group sessions and participation in resident lectures facilitated basic understanding of select
Volume 68, no. 4s : October 2016
disease processes. Supplemental handouts served as reference to aid with documentation requirements. Readings from select textbooks and proctored shifts taught scribes how to write eloquent patient histories and accurately record charting elements. Hands-on experience and participation with simulation sessions during intern boot camp helped scribes to become familiar with commonly encountered procedures and management of critical/advanced cardiac and trauma life support cases. Scribe performance is constantly evaluated via chart audits and provider evaluations. Scribes received basic research training via the collaborative institutional training initiative through the University of Miami to enroll patients in department research studies. Conclusion: Providers quickly appreciated use of scribes as shown by a Likert scale survey at the end of the first six months of the program. Scribes were felt to increase provider well-being, billing, efficiency, number of patients seen per shift and decreased the amount of charting time. The demands of emergency physicians can be exhausting. Scribes have been shown to decrease the amount of time required for documentation likely improving physician well-being and decreasing burnout. A scribe program can be easily manufactured by utilizing instructional modalities already known and experienced by physicians.
TF3
Sono Buff, an Online Multimedia Point of-Care Sonography Training Instrument Designed for Medical Students, Resident Physicians, and Emergency Medicine Faculty
Hafez NM/Rush University Medical Center, Chicago, IL
Point-of-care sonography (POCS) has become a daily tool in the emergency physician’s arsenal of diagnostic modalities (Moore and Copel 2011). ACEP endorses a wide spectrum of bedside ultrasound studies that it believes to be within the normal scope of practice for emergency physicians (2). CORD felt so strongly about the need for future emergency physicians to be trained in point-of-care sonography that it made ultrasound a mandatory part of residency training (Lewiss RE et al. 2013). In addition to aiding in the daily treatment of patients, POCS has also been shown to have medical legal benefits as well (Stolz L et al. 2015). Despite all of these benefits, training in POCS lacks standardization among medical students, resident and attending physicians. Sono Buff is an online multimedia POCS training program designed to allow asynchronous teaching of the critical basics of emergency ultrasound. The goal of the Sono Buff training program is for the learner to demonstrate his/her ability to recognize common critical images in emergency POCS and identify pathology on these images. Subsequently the learner should be able to obtain and analyze these images on their own. Sono Buff was primarily designed to give the learner the opportunity to attain basic critical skills in POCS prior to attending hands on training courses provided by ultrasound-trained faculty. There are five parts to the program. All components are multimedia slide shows created on the Articulate Story Line II software. The modules focus on knobology/terminology, E-FAST exam, aorta/IVC imaging, basic cardiac imaging and ultrasound-guided vascular access. The evaluation instrument is a series of six questions that will follow an ascending order of Bloom’s taxonomy. This formative evaluation instrument will assess the learner’s ability to recognize normal point-of-care ultrasound images, identify pathology on these images and subsequently demonstrate how they would be able to obtain/analyze these images. POCS is a vital skill set for anyone who provides care to patients in an emergency department. It is recommended by ACEP and CORD and has been shown to increase patient safety, decrease time to disposition, as well as to be medically legally protective. POCS requires hands on instruction; however, classes are often composed of learners who have markedly different levels of understanding when it comes to their knowledge of the critical basics. Sono Buff is an online multimedia learning tool that allows the learner to acquire these basics asynchronously and at their own pace. The addition of this module to hands on instruction will ensure that the limited available instructor time can be focused on an audience with an equal baseline understanding of the subject matter. References: 1)Moore CL, Copel JA. 2011. Point-Of-care ultrasonography. N Engl J Med. 364(8):749-57. 2)American College of Emergency Physicians. ACEP Emergency ultrasound guidelines-2001. Ann Emerg Med. 38(4):470-81. 3) Lewiss RE, Pearl M, Nomura JT, Baty G, Bengiamin R, Dupery K, Stone M, Theodoro D, Akhtar S. 2013. CORD-AEUS: consensus document for the emergency ultrasound milestone project. Acad Emerg Med. 20(7):740-5. 4)Stoltz L, O’Brien KM, Miller ML, Winters-Brown ND, Blaivas M, Adhikari S. 2015. A review of lawsuits related to point-of-care emergency ultrasound applications. West J Emerg Med. 16(1):1-4.
Annals of Emergency Medicine S151