Doctoring Health Care Health Care Reform

Flashcards aren’t just for students…

The memo is in all caps and a bold font.

It rests on my office keyboard, not to be missed.

It is from a senior business office staff member who recently attended a two day medicare coding meeting.

It said…

To: ALL Physicians

RE:  Medicare Meeting Aug 2010

Just a few things that I learned in this meeting that I need to share with you:

1. We cannot bill patients for the smoking cessation code anymore.  I have learned that this is included in your visit and is a red flag for an audit.  Also, some insurance companies were paying us for the smoking cessation code and not paying for the visit.   (Ed note:  The smoking cessation code reimbursed an extra ten dollars.  It required ten minutes, not just saying, “smoking is bad for you…you should stop.”)

2. Continue to use modifier-25 when you do a pacer/ICD check in the office the same day. (Ed note:  There are many modifiers, which I have no hope of ever understanding, which is OK, as the rules change each year.)

3. Effective Oct 13, 2013, there will be new diagnosis and procedure codes codes.  Currently, we have 14,315 diagnosis codes and 3,824 procedure codes.  They are going to 69,099 diagnosis codes and 71,957 procedure codes.

4. Who wants to retire before 2013!!!

On the same day that I receive this memo, I come home to find my wife hunkered over the kitchen table, with a ruler, marker and a square of cardboard.

“What are you doing,” I ask

She tells me, “I can never remember the codes for extended time…So I am making myself a flash card.”

She is a hospice and palliative care doctor. She doesn’t work for the money, but it is only right and just that she be compensated for her work–the compassionate and skillful relief of human suffering.


Few medical interventions, be it drugs, procedures or surgery could rival the benefits of convincing a patient to quit smoking.  But yet, this emotionally draining exercise in futility—which occasionally works—is not only not worth an extra ten dollars, but it might trigger a dreaded recovery audit.

But even worse than de-incentivizing the smoking cessation hail-Mary, or adding over 140,000 different codes to quantify care rendered, is the act of reducing a highly dedicated doctor, charged with providing comfort to the suffering, to making cardboard flashcards so that she can be paid a fair wage.

I hope that when such excessive regulation, or obstacles to providing care are recognized by patients for what they really are: intrusions to the doctor-patient bond, then and perhaps only then, will there be meaningful change.


2 replies on “Flashcards aren’t just for students…”

Where is your PAC? Where is your union? Who is advocating for you guys in the hallowed halls of Congress? Can you not organize? The number of codes you're going to have is just cosmic stupid.

This is what America gets for delivering 100% control of government to a group of ideologues dedicated to a bureaucratic solution to every problem, real and imagined, and wholly ignorant of real-world economics.

Moral of story: don't be seduced by politicians promising transformation.

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