Attributions


I saw and evaluated the patient. I personally reviewed overnight events, vitals, labs and medications. I discussed the case with the Nurse Practitioner and agree with the findings and plan as documented with any changes as discussed in my addendum below.


I saw and evaluated the patient. I personally reviewed overnight events, vitals, labs and medications. I discussed the case with the Medical Student and agree with the findings and plan as documented with any changes as discussed in my addendum below.


Consulting Requests


At the hospital where I work, many of th eresidents on consulting services will try to strictly interpret the consult in an overly leag way. For example, I had a patient with metastatic cancer and we consulted Radiation Oncology, and they would only discuss a bony lesion in the patient's hip, not skull, because they said we consulted them for the hip only. So, if they want to be legalistic in how they answer consults, then I can be legalastic in how I request consults. For services that are extremely difficult to work with, I attach the following to a consult order in Epic:
The consulting service is being asked to provide domain expertise and recommendations on several issues, including but not limited to:
1. Make recommendations on adjustments to all medications related to the consultant's specialty
2. Make recommendations for other possible treatments related to the disease in the consultant's specialty, including but not limited to diagnostic imaging or lab tests, surgeries, or procedures 
3. Assess prognosis and progression of all diseases in this patient that are related to the consultant's specialty
The recommendations should discuss all parts of the patient's anatomy that are affected by disease related to the consultant's specialty.


Documentation Query Responses


This is a response to a coding query from our documentation team:
- The patient has hypomagnesemia
- The patient is clinically obese with a BMI over 30
- The patient has low albumin



Note Requirements



Critical Care
Must have 2 parts:
1. Critical illness. 1 or more organ acutely impaired. High prob of iminent life threatening deterioration.
2. Must intervene to prevent deterioration
3. High complexity medical decision making
Min billing time is 30min

Advanced Goals
Face to Face
Name people who were present
Discuss the diagnosis
Min 16 min. Each added 30min is an extra.

Procedure Notes
Must give a codeable diagnosis or signs and symptoms.
Indication for procedure included ascites
Cannot say diagnostic testing or symptom management



Admission Responses


Got it; we will admit the patient. All of our admitters are busy right now but we will get them in as soon as somebody is available.