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Off-Site Visits and Procedure Encounter (formerly Off-Site Facility Encounter) (101.057)

Off-Site Visits and Procedure Encounter (formerly Off-Site Facility Encounter) (101.057) - Policies, Administrative, UWMF, UWMF-wide, Clinic Operations, Health Link

101.057

UNIVERSITY OF WISCONSIN MEDICAL FOUNDATION
GUIDELINE

TITLE: Off-Site Visit/Procedure Encounter (formerly Off-Site Facility Encounter)

Effective Date: February 2, 2007 Approval: See Authorization
Updated: June 9, 2009
Supersedes Protocol: None Contact: See Author

Reviewed 3/27/12
7/22/09

PURPOSE: To provide directions for Cadence scheduling and Health Link documentation for outpatient
visits and non-office based surgical procedures that occur outside the provider’s primary Health Link
scheduling department(s). Except for exclusions listed below, these directions apply to all Fully “Live”
Health Link sites. Charge-dropping via a Health Link encounter is mandatory at fully live (Phase 3 and
“Big Bang”) sites, but scheduling in Cadence remains optional; the encounter may be created “on the fly”
at site discretion. If sites not yet fully live do choose to use Cadence for Off-Site facility visits or
procedures (it is optional), this policy must be utilized.
Exclusions/Clarifications:
1. This guideline does not apply to hospital rounds/visits on inpatients; current processes should be
followed for in-patient visits at all hospitals (Meriter Hospital, St. Mary’s Hospital, UWHC, and
regional). In cases where the physician sees a patient in consult or in the ER at Meriter (not in the OR),
then the currently used paper card would need to be filled out since these patients would not appear on the
OR schedule.
2. This guideline does not pertain to outreach specialty visits where a Health Link schedule
currently exists and is used to schedule office visits at these locations, but it does apply to Off-Site
Procedures that are then performed at areas hospitals.
3. While OR procedures may be placed in Cadence as place-holders, the charging/documentation portion
of this guideline does not apply to non-office based surgical procedures that take place at any of the four
OR’s (Meriter, UWHC, MSC, TSC).
4. This guideline with regard to non-office based surgical procedures will be replaced by Epic’s “Op
Time” functionality as it becomes available.
5. Residents working in UWMF Clinics are not able to close these encounters.

DEFINITIONS:
a) Off-Site Visit/Procedure: A non-UW facility or a UW department that is not the provider’s
Health Link scheduling department.
b) Off-Site Visit (OSV): Cadence visit type used to make an appointment for visits that occur
outside the provider’s Health Link scheduling department in an off-site facility. Examples of
such visits are nursing home, home, and hospice visits.
c) Off-Site Procedure (OSP): Cadence visit type used to make an appointment for
procedures performed at a location other than the provider’s primary Health Link
scheduling department. Examples of such procedures are stress test and treadmill
done at Cardiology-Atrium or Meriter, ultrasound performed outside the provider’s
primary department, colonoscopy done at Meriter. If an OSP is scheduled in Health
Link/Cadence for one of the four OR's (Meriter, MSC, TSC, UWHC), the encounter
should not be opened and documented in. In these cases, the OSP would serve only
as a place holder in the physician's schedule; coders capture charges in each of the
OR settings. OR documentation should continue to be dictated(versus using charting
tools or typing) until Epic Op-Time becomes available.
d) Off-Site Visit/Procedure Encounter (formerly in Health Link chart review as Off-Site
Facility): The Health Link encounter type in chart review to which OSV and OSP convert.
e) Legal record for Off-Site Visit/Procedure Encounters: If the visit occurred at an off-site
facility and the patient is a permanent resident, that facility is the owner of the legal record
and documentation resides in their record.

If the patient is not a permanent resident or the procedure was performed at a UWMF or
UWHC department or facility, UWMF or UWHC owns the legal record and documentation
resides in Health Link.



Off-Site Facility Legal ownership of Medical
Record
Skilled Nursing Facility Facility
Hospice Hospice
Meriter Atrium UWMF
Meriter- Surgery Meriter
Madison Surgery
Center/Transformations
Madison Surgery Center
Home UWMF

GUIDELINE: Reception staff will schedule appointments for off-site visits and procedures. Clinical
staff and providers will document according to the following procedures.

PROCEDURAL STEPS:
OFF-SITE VISIT (OSV):

Reception Staff:
1. Use visit type OSV to schedule appointment for off-site visits, such as nursing home, home,
or hospice visit.
Make the appointment as OSV in an unavailable time slot on the day that the visit
occurred (including weekends, holidays, and days with no provider template).
Unavailable slot reason should be “Off-site patient care”. Do not remove the
unavailable time before making the appointment.
This appointment may be made up to 7 days after visit occurred. (Status=Arrived)
Indicate place of service (POS) in appointment note.

Providers :
1. Notify scheduler to make appointment for an off-site visit if not already done.
2. Document encounter in Health Link:
a. From the Health Link schedule, open encounter. Visit Navigator will include:
 Chief complaint: Enter NH (nursing home/home visit, #175), Home
(nursing home/home visit, #175), or Hospice (coordination of care, #261),
1. In Comments enter name of off-site facility, or location.
 Medication documentation (not required to close encounter)
 Progress Notes
1. UWMF-owned legal record: Document notes or dictate; indicate
place of service.
2. Non-UWMF-owned legal record: Use .OSV smart phrase which
expands to read “Complete legal documentation resides at ***”.
Indicate the place of service.
 SmartSet
 Diagnosis & Orders (Non-Schedule Medications Only – Able to be faxed.
Schedule medications should be ordered via a paper script.) - entering
diagnosis is mandatory for Full Health Link sites. You may order
procedures, supplies (example IUD), lab, or radiology orders for this visit
from this field.
 Follow-Up
 LOS (Mandatory for Fully live Health Link sites)
 Close Encounter

Notes:
- HCPCS codes G0180 and G0179 will be available for health assessment for LOS.

- OSV converts to encounter type Off-Site Visit/Procedure. All Off-Site
Visit/Procedure encounters go to a work queue for coders to review and enter
the correct place of service.
- Do not rely on Health Link medication documentation list to be accurate for patients
who are permanent residents of non-UWMF off-site facilities.
- Coding or Clinical staff may assist with entering the CPT and Diagnosis Code
information that the provider has selected, and providers will co-sign.
- Residents: If the resident sees patient without faculty present, LOS is entered as
05269 “Resident Only visit Attending not present” and is no charge. This is an
option available to them in the smartset. If the resident sees the patient with the
faculty the resident will enter the appropriate LOS and forward to the faculty for
review and close.

Clinical Staff:
1. Telephone encounters regarding patients who have permanent residence in off-site facilities
(nursing home, hospice) may be opened (optional) for communication during clinic hours that
involve clinical or reception staff at the discretion of the clinical staff.
2. It is not expected that medication lists be maintained in Health Link for permanent off-site
facilities residents. Medication lists should be updated when next office visit occurs.



OFF-SITE PROCEDURE (OSP):

Reception Staff:
1. Use visit type OSP to block the schedule for a procedure performed by a departmental
provider at a location other than provider’s primary Health link scheduling department,
such as a procedure at 1South Park Radiology, Meriter, Transformations or Madison
Surgery Center, colonoscopy at Meriter, ultrasound outside primary clinic, or stress test
at Cardiology-Atrium or Meriter.
a. Per provider request, schedule appointment as OSP in unavailable slot(s) on
applicable day. Unavailable slot reason should be “Off-site patient care”. In
appointment notes, indicate procedure being done and place of service
(example: Meriter hospital).
b. If the procedure is performed at a UWMF location, the procedure must be
scheduled with the correct visit type for that procedure as a single appointment or
as a resource (such as the room or equipment) scheduled in the
department/location where the procedure will take place. For example, a Monona
physician doing a treadmill at Meriter- Atrium Cardiology would have an OSP
scheduled on their Monona schedule and the procedure scheduled in the
Cardiology department as a separate appointment. The scheduling staff must
have "overlapping security" assigned to them. This allows the patient to be
scheduled in two different departments with two different visit types at the same
appointment time: 1) the provider's primary scheduling department with an OSP
visit type, and 2) the department where the provider will perform the procedure.
This would be true for all OSP’s where the MD and procedures are both on UW
Health schedules in Health Link (Epic Cadence), whenever the doctor leaves his
home site to go to another UW Health site with a Cadence schedule.
c. If the procedure is performed at a non-UWMF facility, the procedure is
scheduled only in the provider’s Health Link scheduling department in an
unavailable slot. For example, a surgery performed at Meriter by a 20 S. Park
OB/GYN physician would only be scheduled in 20 S. Park OB/GYN.
2. The appointment will be arrived when the encounter is opened and information is
entered.

Providers:
1. Document procedure in Health Link for non-OR based procedures only.
(Providers may chooses to indicate OR time in Cadence, but should not open or
document these in Health Link)

a. From Health Link schedule, open encounter.
b. Visit Navigator will include:
Chief complaint: Enter “Off-site procedure”- indicate specific procedure,
location and referring doctor if applicable.
Medication documentation (not required to close encounter)
Progress Notes
 UWMF-owned legal record: Document notes or dictate, indicate
place of service
 Non-UWMF- owned legal record: Use .OSP smart phrase which
expands to read “Procedure performed and complete legal
documentation resides at ***.” Indicate place of service.
SmartSet
Diagnosis & Orders (Fully “Live” Health Link sites only) - Enter applicable
diagnosis and reason for procedure. You may order procedures, supplies
(example IUD), lab, or radiology orders for this visit from this field. If a
medication is administered in conjunction with the procedure and the
medication should be on the patient’s medication list (i.e. Mirena IUD is
inserted with ultrasound guidance at 20 S Park OB/GYN by a non-20 S
Park OB/GYN provider) the medication should be ordered. SmartSets
may exist for such situations and should be utilized.
Follow-Up
LOS (Mandatory for Full Health Link sites)
Close Encounter
Notes:
- OSP converts to encounter type Off-Site Visit/Procedure. All Off-Site
Visit/Procedure encounters go to a work queue for coders to review and enter
the correct place of service.
- Coding or Clinical staff may assist with entering the CPT and Diagnosis Code
information that the provider has selected, and providers will co-sign.

OSV and OSP visit types will be excluded from scheduling department ambulatory reports.
(Production credit is not based on scheduling appointments.)

REVIEWED BY:
Health Link Clinic Operations Work Group
Marcy Dennis, Senior Clinical Analyst
Jody McClain, Patient Business Services
Sylvia Spinner, Decision Support
Sandy Jacobson, Clinic Manager
Sara L’Herault, Clinic Manager
Laurie Woodhouse, Clinic Manager
Mary Waldo, Director of Compliance
Jennie Cullen, Director, Clinic Operations
Donna McNutt, UWHC Cadence
Patricia Haack, UWMF Cadence

AUTHORIZATION:




Medical Director Date