MikeS. wrote:AJMD, what are these?
sell "ICD-9 and CPT coding reference materials
Thanks
Well, it is way OT but here's the deal:
It used to be we charged basically for our TIME since that was usually the defining overhead. If there was a specific procedure which either required materials of significant cost, or unusual expertise or liability, we'd charge for that - say setting a fracture.
NOW it is all "codified" and you have to specify the numeric code for what you treated (i.e. you can't just say an "upper respiratory infection" you have to specify "sinusitis, maxillary, bacterial" or some such, and there is a 5 digit number for it. The ICD books list all those numbers for diagnoses.
The CPT is even worse. You have to tally up how many questions you asked about the patient's history, how many body parts you examined, and how intensely you examined each part (i.e. the exam has to include enough itemized things THEY say are important about a given body part), and then how 'complicated' the matter is (again, according to a complex checklist involving how many tests were ordered, etc.).
The codes change each year, and mostly so you have to buy new books and software for hundreds of dollars each.
They waste LOTS of time and money because you have to hire 'coders' who 'interpret' the vague language for you and hopefully keep you from being fined or jailed (if it is a medicare or medicaid patient a mistake constitutes 'fraud' regardless of intent). They ALSO waste lots of patient's and insurer's money because most doctors realize that the fastest way to be sure you get a higher CPT level (more pay) is to game the system and order lots of tests (it is more concrete in the chart if you have an X-ray order, than to take the time to document the sixteen things they want you to examine, which may have NOTHING to do with reliably evaluating that body part, so you can't just do "good medicine" and examine the area as you're trained, document it, and charge for the visit - you have to look up what the CPT book thinks are the important things to document, and do THEM (most of the time I'm convinced doctors fake it anyway), and that takes so much more time and is easier for a hostile auditor to pick apart (i.e. you didn't describe the breath sounds using the word 'auscultate' so it doesn't count!) so you just figure screw them and order an X-ray.
In the old days you wouldn't order the X-ray unless necessary, because the patient would have to pay for it, and they would be going somewhere else for it, so you wouldn't get richer for it. NOW, most physicians are seeing patients whose insurance covers everything, and the insurance has us so angry that we LOVE to waste their money - bankrupt them if we could. Of course it falls back on the patient later when premiums rise, but we are ALSO angry at the patient, because they are the idiots who petitioned their union bosses to get that fancy coverage that costs them a bundle but doesn't really pay for anything the patient needs, and doesn't pay us well at all.
The insurances won't pay more for a better job (we used to charge $26 for an office visit even though the other doctors in the area charged $22, because we spent about 25% more time with our patients, and were willing to treat multiple problems per visit. Patients GLADLY paid the difference, we were flooded with business, and made good money. NOW it is all "covered" by insurance, who set flat fees by the code books, so EVERY doctor gets paid the same to treat the sinus infection, regardless of whether they whisked in the room for 30 seconds, or were in there for 10 minutes, explaining how to prevent further infections, and took the time to answer a question about diet and cholesterol. So, of course if you go to Olive Garden with a White Castle coupon, you're going to get less than the usual quality they offier. Nowdays doctors have the attitude that "if you want to ask me about three things, then schedule three appointments, take three days off work, and if that makes you mad, then instead of showing up with your Anthem card, show up with your MasterCard."
Of course if they do that (with Medicare and many insurance plans it would be ILLEGAL for the patient to directly pay the physician that way, even if they wanted to), and you charge them for your service, they are outraged that it costs more to treat pneumonia than to have your oil changed (so I tell them to ask the guy at McQuicks to treat their pneumonia
). Somehow it doesn't sink in that they are making about $5,000 dollars less per year so they can have that stupid Anthem card, and that doesn't make them as mad as a $50 charge to treat an illness - go figure!
So - ICD and CPT are just one more part of our socialized, over-regulated, and corrupt 'system.'
, love the inside medical info you contribute, will share the link with the folks out here in "Hillarys-health experiment-land of Hawaii". Here's the latest damage: 