ordering labs

[rohit76]

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I have started working in a community ED. I was told by the ED clerk that I have to document symptoms for ordering the labs in the chart. She was talking some rules like only nausea can not justify BMP. Patients should have nausea with vomitting to justify ordering BMP. Have you heard of weird comments like these before?

 

[Seaglass]

I have for radiology studies but not labs. It is probably a reimbursement issue.

 

[kungfufishing]

that sounds like a PITA.


"old"

 

[diphenyl]

I only have to do that for radiology. Like to justify a chest X ray CP or sOB is sufficient. We can't use "r/o XYZ" to justify like a CT anymore we have to put "abdominal pain r/o appy". Never heard of this for labs.

 

[Apollyon]

If you put "rule out" or "r/o" on an order, rads can't bill for it. It's just verbage, but use "possible".

 

[Jeff698]

I have started working in a community ED. I was told by the ED clerk that I have to document symptoms for ordering the labs in the chart.

Well, at least we know who is in charge of medicine these days. Ever feel like you need to get the clerk's permission to do something?

Take care,
Jeff

 

[southerndoc]

Our secretaries are pretty good. They just read it off our chief complaint and enter it automatically.

 

[Hawkeye Kid]

Well, at least we know who is in charge of medicine these days. Ever feel like you need to get the clerk's permission to do something?

Take care,
Jeff

Not as much as I feel the need for permission from the XR/CT techs, especially when I either don't want po contrast or don't want a C-spine CT with the head CT.

 

[skiz knot]

I have started working in a community ED. I was told by the ED clerk that I have to document symptoms for ordering the labs in the chart. She was talking some rules like only nausea can not justify BMP. Patients should have nausea with vomitting to justify ordering BMP. Have you heard of weird comments like these before?

What a load of crap! Make up some BS if you need to. E.g. nausea potentially from ileus 2ry to lytes imbalance, esp K+.
The policy is however, a good exercise in thinking about what and why you are ordering a lab.

 

[beyond all hope]

There will be a lot of people who try to tell you what to do in your practice. Some people are concerned about compensation, others about medicolegal issues. Some people are just darn ornery.

Bottom line: you're the doctor. If you need the test, get it. You may have to fudge your documentation slightly, bend a few truths, yell, scream, or do whatever is necessary.

Of course, you have to choose your battles. You can't do this every time.

I've worked in a lot of different ERs. When you first show up, you have to softshoe it and win the team's respect, meaning you have to play by their rules for a little while. You will change your practice slightly in every different place you work. After you understand the system, then you teach them how you practice.