Coding, more complicated than da Vinci


I’m not in the overcharge mode

But adequate coin I have stowed

It just seems to me

I shouldn’t need a degree

To figure out the right code.

Synopsis:  I’m a family practitioner from Sioux City, Iowa.  In May 2010, I left my position of 23 years, and honoring my non-compete clause, traveled for a year doing locum tenens work.  In June of 2011 I joined up with the Community Health Center, which provides care for the underserved.  I’m now working part-time, which, for a doctor, means 54 hours a week.

In residency, I worked for a month in Thermopolis, Wyoming; the title of the rotation was Supervised Rural Practice Elective.  I had my entry into the idea that I might receive money for my work.  My preceptor, a surgeon, charged $15 for an office call, and felt that I should, as well.  Of that amount, $5 would cover overhead, $5 would go to the preceptor, and $5 would end up in my pocket.

Shocked and horrified that I’d make more money than I had intended, I protested that my $1,300 per month salary covered me.

The preceptor wouldn’t hear of it, and insisted I get my share of the proceeds.  In the end, I caved.

I had a great time and met some wonderful people, including a real author, Win Blevins.  I felt funny about taking money for my services.

From that time in 1981 till I left the Indian Health Service in 1987, I didn’t worry about billing—I was on salary.

By 1987, faceless sectors of the government had decided that cognitive medical services could be stratified into six levels, excluding procedures. 

The Omnibus Budget and Reconciliation Act (OBRA) passed in careless haste in 1989, declared six levels excessive, and consolidated things into five, partly in a move to decrease Medicare/Medicaid spending.  But the same act greatly increased the difficulty of deciding the complexity of a medical visit by declaring the existence of a code for every medical service.

(CPT or Current Procedural Terminology codes have to do with what the physician did; ICD codes refer to with diagnoses; the government proposes that in 18 months those codes attain a level of complexity literally 10 times greater than current.  Most docs do not know that ICD stands for International Causes of Death.)

I attended lecture after lecture, trying to understand how to code.  Eventually, the (then) six docs at the Practice Formerly Known As Mine, hired a professional coder.  She tried to start by giving us the essential theory of coding.  We stopped her.  Each of us had been through a minimum of 8 hours of instruction, we said, and none of us understood, and could you please go over some charts with us?

We recouped the price we paid the coder before the sun set; we had undercoded everything up till then.  We brought the same coder back every 6 months to do chart audits.  We continued to undercode but we made improvements.

I left private practice, but even in a salaried position in a Community Health Center, coding has raised its ugly head, now much more complicated than ever before.  The Coding Consultant came on Friday.

She gave a general lecture for an hour, went into some specifics for the practice for an hour, than six of us got one-on-one sessions. 

I started my half-hour with observing that coding has attained layers of complexity resulting in an academic discipline in which one may now earn a 4 year degree, and, at this phase of my career, I wasn’t about to start that course of study.

I still undercode, but not as badly as I once did; I could have billed approximately twice as much for hospital charges as I did for more than 15 years. 

Sure I feel stupid, but those mistakes have passed, and, having learned from them, I move on.

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