1.

ETHICAL PROBLEM: Documentation and DRG Assignment

Steps

Information

1. What is the
question?

The question is do you leave the cardiac diagnosis and let the hospital receive a lot more
money, or use the diagnosis the doctor came up with after the cardiac cath and receive a lot
less?

2. What are the

facts?

KNOWN
1) The cardiac diagnosis from the H&P
will give the hospital $11,750.
2) The COPD diagnosis, which was final,
will give the hospital $7,300.
3) The COPD code does not recognize the
cardiac cath procedure, which will cost
the hospital $5,500.

3. What are the

values?

Patient: The patient doesnt want to be charged more than he should be, or have a false
diagnosis on his record. The patient just wants to worry about getting better.

TO BE GATHERED
1) Does the doctor believe that there is still a
chance that the patient has the cardiac diagnosis?
Or should he remove this from the H&P.
2) Does the doctor want a further work up?

HIM Professional: Needs to make sure the record is complete and ACCURATE. This means
they need to value having the right diagnosis on the chart.
Healthcare Professionals: Need to value how the patient is taken care of and make sure they
are treating him for the right diagnosis.
Administrators: Need to value how the hospital is perceived, and ensure that people still want
to come there.
Society: Wants to know that the hospital they are using for their healthcare needs is being
ethical in the way they treat them.
4. What are my
options?

To leave the cardiac diagnosis and collect more money for the hospital or remove the cardiac
diagnosis, receive less money, but know it is the patients true diagnosis.

5. What should
I do?

Remove the cardiac diagnosis. As an HIM professional it is our duty to make sure the patients
chart is accurate and to ensure proper care of the patient. We want his correct and final
diagnosis to be the one coded.

6. What
justifies my
choice?

7. What can I
do to prevent
this ethical
problem?

JUSTIFIED
Caring for the patient.

NOT JUSTIFIED
Leaving a false diagnosis, just the gain the
hospital more money.

Remove any wrong diagnosis from the chart and make sure the patient is being treated the
way he needs to be.