COVID-19 Medical Record Language

Thursday, April 2, 2020

A Message from Paul Orcutt, M.D., FACEP, PhyCon Chief Executive Officer

There are too many uncertainties to get the true information, rumors and consequences of the Covid-19 virus epidemic at this point, along with the passage of an 800-page bill by Congress. At this time, I would like to make one point that may save you and your hospital’s balance sheet.

CMS has promised the moon on COVID ED care, but they have not given a directive as just how this will happen.

Therefore, we feel it vital to document that you were considering, examining, and testing the patient for a possible Covid-19 infection. Your hospital and the ED could develop a statement placed in the patient chart that would say something to the following effect:

 “**Patient Name** was evaluated in the Emergency Department on **Date** for the symptoms described in the history of present illness. Patient was evaluated in the context of the global COVID-19 pandemic, which necessitated consideration that the patient might be at risk for infection with the SARS-CoV-2 virus that causes COVID-19. Institutional protocols and algorithms that pertain to the evaluation of patients at risk for COVID-19 are in a state of rapid change based on information released by multiple regulatory bodies including the CDC and Federal and State Organizations. These policies and algorithms were followed during the patient's care in the ED.”

Having placed a statement on the patient record will be very important for the hospital as well as the ED group in the event the record is not properly reimbursed. Please have your team address this ASAP. When and if the record is denied payment, you and the hospital will be protected when the patient’s record is appealed by PhyCon. We will argue this for you and the hospital.

In addition, I have asked our coders to immediately begin tracking patients that are being tested or suspected to have symptoms of COVID-19 so that we can start reporting these figures at your request or adding this report to your End of the Month Reporting Packet. Moving forward the following tracker codes will be in place for all PhyCon clients:

800POS – Positive Test
800NEG – Negative Test
800UN – Suspect / Unknown or Not Tested 

Should you have any questions related to this information, please call Todd Baker at (972) 567-9176. Todd will be able to set up a call with the appropriate PhyCon representatives (including me if necessary) to answer all your questions. 


Paul Orcutt. M.D. FACEP 
Chief Executive Officer 
PhyCon, Inc.