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Criteria for Inpatient Daily Care Level 5 Charge - Flap or Replant Patients (9.08)

Criteria for Inpatient Daily Care Level 5 Charge - Flap or Replant Patients (9.08) - Policies, Administrative, UWHC, Department Specific, Nursing Administrative, Patient Charges

9.08

POLICY & PROCEDURE





Effective Date:
May 31, 2017

Administrative Manual
 Nursing Manual
 Other _______________

Policy #:
9.08

Original
Revision

Page 1
Of 3

Title: Criteria for Inpatient Daily Care
Level 5 Charge – Flap or Replant Patients




I. PURPOSE:
A. Patients will be charged a higher daily care rate when they are admitted to selected
inpatient units and meet certain criteria as specified in the Policy section below.
II. POLICY
A. This Daily Care Level 5 Flap or Replant charge applies primarily to the Gynecology,
Urology, Plastics and Otolaryngology (93610) inpatient unit, the Orthopedic (93430)
Inpatient Unit, and Pediatric General Medical/Surgical Unit (93410). These patients
require multiple nursing interventions as described below, and to qualify for the higher
charge must have a Flap surgery or Replant and meet 2 or more or the following criteria:
1. Requires monitoring of surgical site every 2 hours or more frequently to ensure
flap/replant viability
2. Requires leech therapy
3. Requires bed rest and the assist of 2 or more staff for repositioning, toileting, or
bathing
4. Requires staff to feed
5. Requires a bowel program due to paraplegia or quadriplegia
6. Has cognitive impairment (alcohol/drug related, dementia, and/or behavioral
health)
7. Requires safety checks every one-hour
8. Requires continuous pulse oximetry monitoring
9. Requires vital signs every 2 hours or more frequently
10. Requires serial hematocrit monitoring
III. PROCEDURE
A. Upon Admission:
1. If patient meets the criteria section listed above then they should receive an
Inpatient Daily Care Level 5 - Flap or Replant charge until such time as the charge
criteria is no longer met. The admitting nurse communicates to the Health Unit
Coordinator (HUC) or Patient Care Technician (PCT) the need to implement the
Level 5 daily care charge. The HUC/PCT will enter the Level 5 accommodation
code into the Electronic Medical Record (EMR) in order to change the daily care
charge. The correct accommodation code must be entered into the EMR system
before midnight on the day of admission in order for the patient to receive the
charge applicable to the first day of the stay.

POLICY & PROCEDURE





Effective Date:
May 31, 2017

Administrative Manual
 Nursing Manual
 Other _______________

Policy #:
9.08

Original
Revision

Page 2
Of 3

Title: Criteria for Inpatient Daily Care
Level 5 Charge – Flap or Replant Patients




2. It is the responsibility of each Nurse Manager (NM) to specify which staff
member is accountable for charge entry when a HUC/PCT is not working.
Generally, the task of assuring correct charges are reflected in the system will be
assigned to either the Care Team Leader (CTL) or the admitting nurse when a
HUC/PCT is not available. The assigned staff member is responsible for entering
the Level 5 accommodation code into the EMR
3. The defining criteria for a level 5 Flap or Replant charge will be available 24/7 on
UConnect for use by staff.
B. Days following admission date:
1. The Level 5 Flap/Replant charge is evaluated for appropriateness on each Day
shift following admission, and will be discontinued when the patient no longer
meets the charge criteria listed above. The nurse assigned to the patient
communicates with the HUC/PCT when the Level 5 Flap/Replant charge should
be discontinued. To discontinue the Level 5 charge will require changing the
accommodation code to General Care.
2. It is the responsibility of each NM to specify which staff member is accountable
for charge entry when a HUC/PCT is not working. Generally, the task of assuring
correct charges are reflected in the system will be assigned to either the CTL or
the admitting nurse when a HUC/PCT is not available. The assigned staff member
is responsible for entering the Level 5 accommodation code into the EMR
C. Daily Patient Charge Review:
1. On a daily basis, the Manager or Manager’s delegate (e.g. CTL/Senior Team
Member (STM) or HUC/PCT) is responsible for reviewing all active charges
before midnight and for assuring that all patient charges are correct for the
midnight charge capture. Data pertinent to the daily care patient charges can be
found in either the home page patient list or the unit census snapshot report in the
EMR
2. On a daily basis, the Manager or Manager’s delegate (e.g. CTL/STM or
HUC/PCT) must review the Revenue and Usage Report which lists all charges
posted for a patient the previous midnight. A comparison of the Revenue and
Usage Report with the unit census snapshot run for the previous 24 hours will be
conducted. Any patient charge errors discovered as a result of this review will be
corrected immediately. If the patient is not yet discharged, corrections can be

POLICY & PROCEDURE





Effective Date:
May 31, 2017

Administrative Manual
 Nursing Manual
 Other _______________

Policy #:
9.08

Original
Revision

Page 3
Of 3

Title: Criteria for Inpatient Daily Care
Level 5 Charge – Flap or Replant Patients




made in the EMR by the unit staff. If the patient has been discharged by the time
the error is discovered, the unit staff will notify the Admissions Department.
Admissions will then correct the charge error when feasible to do so.


IV. AUTHORED BY
A. Director, Nursing Finance and Staffing Effectiveness


V. REVIEWED BY
A. Nurse Manager, D6/4 – Neurosurgery, May 2017
B. Nurse Manager, F4/4 - Surgical Trauma Unit & B6/4 - Orthopedics, May 2017
C. Nurse Manager,, F66-Gynecology/Urology/Plastics, & Otolaryngology, May 2017
D. Director, Surgical & Psychiatric Nursing, May 2017
E. Nursing Informatics, May 2017
F. Nurse Manager, P5 – Pediatric Medical/Surgical, May 2017
G. Nursing Administrative Policy & Procedure Committee, May 2017


SIGNED BY:
Beth Houlahan, DNP, RN, CENP
Senior Vice President
Chief Nurse Executive