Comments on: Diagnosing and treating disease is only a small part of a doctor’s job

By: Proactive Patient Podcast 2 – Get a Translator! :: Cancer for Christmas: Making the Most of a Daunting Gift

Mon, 30 Nov 2009 14:56:45 +0000

[...] terrific post on the equally terrific blog by Dr. Kevin Pho – who makes me wish I lived in Nashua, NH, [...]

By: Marie C

Marie C — Sat, 07 Nov 2009 15:20:12 +0000

There absolutely are codes to cover prolonged, face to face physician services. You need a good coder but more than anything you need good documentation.

It does take some extra paperwork (i.e. notes documenting the encounter), but it pays to be a compassionate physician. The compensation is not simply monetary. It is good for the patient and it is good for a doctor to be empathetic and responsive. I don’t think I would be too presumptuous to say that is what most people had in mind when they went to medical school.

It is a good thing to be good TO people not just good FOR people. It is even better to get paid for it.

By: Doc Stone

Doc Stone — Fri, 06 Nov 2009 01:28:48 +0000

Ralph:

If you don’t care if you get paid for it, then who does? If patients and third party payors aren’t going to attach more monetary value to your time than you do.

The attitude of feeling superior and generous about ones self-sacrifice is fairly strong in primary care and is a false generosity. It’s end result is to obstruct the fulfillment of the needs of patients. It is because this generation of primary care doctors have failed to demand that an appropriate value be put on their labor that they next generation of patients may not access to primary care physicians at all.

I agree whole-heartedly with commitment to patient need and to the ethical requirement of not abandoning ones patients or of not reducing service based on discovering that the one will not reimbursed. But one must not denigrate the value of the work and must defend that value in every way possible (usually by collecting for it!) as a obligation to the well-being of the profession for the benefit of the patients it serves.

By: GingerB

GingerB — Fri, 06 Nov 2009 00:40:47 +0000

If memory serves me the “Interpreter of Maladies” in the story was not an MD but a taxi driver the woman on the trip told the story of her affluent self-centered life.

By: jsmith

jsmith — Thu, 05 Nov 2009 20:48:33 +0000

“Much of the work you did today cannot be billed for.” Hence the primary care shortage.

By: Ralph

Ralph — Thu, 05 Nov 2009 20:29:14 +0000

Yes, you are right. There is a code for a prolonged care. The problem is that it has to be provided at the bedside so family meeting in a conference room would not qualify. And, I believe Medicare (most of our patiens) still would not pay for it. Having said this, I am not a coder and I might be wrong about some of it.
In reality though, I don’t really care if I am going to be paid for it or not, It just something that needs to be done.

By: Doc Stone

Doc Stone — Thu, 05 Nov 2009 00:13:12 +0000

The CPT codes allow you to upcode according to time when you spend most of the time counseling. So there is a place on the insurance form for the effort as it can be reflected in the CPT charge without meeting the history, physical, and complexity criteria.

By: Ralph

Ralph — Wed, 04 Nov 2009 21:12:49 +0000

I agree. My primary practice is ICU and Hospital medicine. There is just so much more to it than seeing patients, writing orders, managing vents etc. Talking to the patients and their families takes a significant portion of my day. Some family conferences take more than an hour. For the families to be able to make decisions regarding their critically ill loved ones, you have to provide a lot of education. Sometimes, you have to do it again and again.
At the end of your day, when you sit down to do your billing, you realize that much of the work you did today cannot be billed for. And it’s Ok, since that what it takes.