By Debra West, RN, BSN, BSN, CCM
A close, knowledgeable analysis of what is written in the medical records can provide critical information when determining whether an injury is acute. This can be a challenge to a non-medical observer, since medical terminology is highly technical and often difficult to understand.
A case in point
A male patient reported that a five-pound object fell off a shelf while he was shopping in a store. It struck the right side of his face and eyebrow, resulting in multiple complaints, including a laceration with profuse bleeding.
The patient did not seek medical care until four days after injury. The examining doctor documented a two-inch scar on the patient’s right eyebrow.
Knowledge is power
A well-trained and experienced medical provider knows that a scar has to predate this patient’s injury. While a four-day-old injury would show signs of healing, it would not have healed enough to form a scar.
Scar tissue does not occur until at least four to six weeks after the injury, with complete maturation of the scar taking months to years to develop. The fact the patient had an identifiable scar indicates that the facial laceration did not occur four days prior as the patient alleged.
While the word “scar” may seem insignificant, it is critical in this patient’s case, as it validates the timing of the injury. It is evidence that the patient sustained an injury months to years prior to the alleged incident four days before being examined. The presence of a notable scar provided the necessary timeline which allowed the adjuster to dispute the alleged injury.
Understanding medical terminology can prevent a fraudulent claim. When properly interpreted, words which might seem trivial or unclear can hold the key to determining acute verses chronic.
Debra West is a registered Legal Nurse consultant with MKC Medial Management. Contact Debra at firstname.lastname@example.org or 865-551-6800.