by Sandeep Grewal, MD
We as doctors and patients as well as medicine as a whole have evolved over time. What used to be a simple conversation of between a doctor and a patient has turned into a melee of medical issues, legal issues, insurance and financial issues and not to mention the complicated ICD 9 and CPT code system.
Conversation between a doctor and patient in 1960s:
Patient: Sir, I am having a sore throat for last few days with some cough but no fever.
Doctor: You need to go home, take some rest and don’t forget to drink some nice hot tea.
Conversation between a doctor and patient in 1980s:
Patient: Doc I am a having a sore throat for last few days with some cough and no fever.
Doctor: Why don’t you take this antibiotic for five days. Also don’t forget to rest. And let me check you for strep throat too.
Conversation between a doctor and patient in 1990s:
Patient: Doc I am having a sore throat without fever. I need to know what it is right now. Do I have cancer? Do I have something more horrible than cancer?
Doctor: Well seems to me just a simple infection. But to be on the safe side let us send you to ENT specialist for further check up. By the way the strep test is negative.
Patient: Are you sure there is no cancer? My brother is a malpractice lawyer.
Doctor: Ah well! Let us also get a CT scan on your throat.
Conversation between a doctor and patient in 2000s:
Patient: Doc I am having a sore throat and cough. What can I do to make it go away right now?
Doctor: Let me see. Your strep check is negative. My lawyers want me to send you to an ENT specialist and get a CT scan of your neck. Also some blood work. And I have this big gun antibiotic for pneumonia you can use.
Patient: But will my insurance pay for it? I need something they will pay for.
Doctor: Then why don’t you just go home and take rest and drink some hot tea. I will write in the chart you declined my recommendations due to financial reasons.
Conversation between a doctor and patient in 2010:
Patient: Doctor I have sore throat and fever. I tried everything I was told to on a health forum online. But it is getting worse.
Doctor: You have 462. Your 87880 was negative. My lawyers require me to get 88.38. In fact if 88.38 shows that you have 475 rather than 462 then you will need 42821. You have to remember that your chances of having 475 rather than 462 are quite low. But an undiagnosed 475 can lead to 995.92. That will lead to 99223 and possibly 99291 or 99292.
Patient: I don’t understand but will my insurance pay for it?
Doctor: Well 99212 is covered because 462 is a covered diagnosis. Your 87880 is also covered by 462. 88.38 may not be covered because of medical necessity but my lawyers need it.
Patient: I really don’t understand
Doctor: Don’t worry! Neither do I.
ICD-9 and CPT code key:
99212 Low level Physician Visit
88.38 CT Scan NOS
87880 Strep test
462 Acute Pharyngitis.
475 Quinsy (Peri-tonsillar abscess)
995.92 Severe sepsis
99292 Critical Care attention
99291 Critical Care attention
99223 High level Hospital Admission
Sandeep Grewal is an internal medicine physician who blogs at CareerMedicine.com and is the author of CareerMedicine.com’s Mini-Guide to Physician Job Search.
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