You are a clinical documentation improvement coordinator and a liaison to the HIM department. You are reviewing the record for a discharged patient…
Question You are a clinical documentation improvement coordinator and aliaison to the HIM department. You are reviewing the record for a discharged patient that you received for review due to a rejected claim. You notice that there is documentation of medications administered to the patient in the progress note indicating blinatumomab infusion. However, the medication reconciliation section in the EHR states blood infusion. As you continue to look through the patient record, you confirm that blinatumomab is the correct infusion and note that the correct infusion is billable for $6,900 more than the blood infusion. You look through your database and find that this same error happened six other times this year. Since there is a pattern for blood infusion being coded and billed for blinatumomab infusion, you pull up the medication reconciliation section of the EHR and discover that there is a drop-down box for infusions, and the choices are alphabetized. Blinatumomab infusion comes right before blood infusion. You have brought this issue to the attention of your supervisor. Your supervisor has asked you to provide a report for senior management regarding the error, recommend a corrective action plan, and discuss further legal issues and responsibilities for HIM professionals. 1.Discuss the quality of care and legal issues related to the data entry errors described in the scenario. should I include different types of medication administration in the answer for the quality of care portion of the question? Health Science Science Nursing C 806 Share QuestionEmailCopy link Comments (0)
