ED Coding and Reimbursement Alert

Question: When a doctor turns a patient over in the middle of his visit due to a shift change, does the physician turning over the patient need to make a note stating something like "Patient turned over to Dr. B at change of shift. She will continue care and make final disposition"? Or does the second doctor just have to sign behind the first?


Michigan Subscriber

Answer: There is no foolproof, ultimate guideline about what to do in this situation - it's entirely an internal group decision. Some practices prefer to have the first doctor sign it, while others prefer to have the dispositioning physician's signature. Most groups feel strongly that any physician involved in the patient's care should sign the chart. The issue then becomes one of a productivity-based compensation formula used by the group: Which doctor should get credit for treating the patient?

To distribute revenue fairly, what matters most is that the physicians follow a consistent policy. Most groups gravitate toward the discharging doctor's signature, because that habit tends to motivate people to tie up loose ends at sign-out. Clinically, the major ED decision is usually whether to admit the patient or send her home - and the dispositioning physician makes that choice.

As far as risk management is concerned, your best bet would be to have both physicians sign the chart with a brief note written by the departing doctor, such as, "Signed out to Dr. B. CT scan and repeat belly exam pending."

Studies have shown that signed-out patients carry a higher risk, so tightening the flow of responsibility is a prudent move.