I recently had the pleasure of participating in an administrative law judge (ALJ) hearing. Novitas, the Medicare administrative contractor had denied the E/M code 99291, critical care. The case was appealed to the qualified independent contractor, who also believed that the care, in this case, did not meet the CMS and CPT definitions of critical care. Subsequently, the case was appealed to the administrative law judge. The encounter occurred in an ...

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Our 20-bed ICU finally captured 10 intensivists — all board-certified in critical care medicine. We were fortunate enough to have one of these doctors in our ICU 24-7. Of course, they all practiced professionally with expertise. But I remembered this one the most: Dr. Jason McKenzie (name changed for privacy). He easily became our friend and "go-to" person. Clocking in at night and finding out that Dr. J was our doc, would give me ...

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Halfway into my four-week hematology consults elective at the county hospital during my fourth year of medical school, I was surprised that one of my patients was a 25-year-old woman from Romania — exactly my age. This was highly unusual, as most of the patients I had seen on this service were not this young, especially with a malignancy. What was even more unique was that she had just arrived from ...

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If you went to go to a museum in New York City and saw a live heart encased in glass, still pumping and pulsating — it would be my heart, shredded into a thousand pieces all in disarray. But it still would be pulsating. This describes my life as a nurse. Nursing was a vacuum that sucked me dry and left me dangling with nothing more to give. Three years left ...

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She was a middle-aged female who was life-flighted from an outlying facility to the tertiary care hospital in which I worked. As she quickly rolled out of the elevator, I ran toward her and saw her blood pressure was tanking with her mentation fluctuating. My hair mindlessly placed in a ponytail, my blue scrubs wrinkled, and my nerves a jumbled mess, EMS briefly gave me an account of her history: ...

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Medicine was my path. I’d decided that early in life before I knew what a career in medicine really looked like. I believed as a doctor I could help people and have a positive impact in their lives. After all, what does a teenager know about being a doctor? I’m not a teenager anymore. Here I am at 3 a.m. in the neonatal intensive care unit (NICU) at the bedside of ...

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These events happened over 18 years ago. Some content has been changed to protect the innocent and the guilty. Searching for positive changes in the health care industry. We are not a number, and the patients are not a number. I’m not good at lying. My eyes go to the left or look downward, and I start to stutter and pause. There is no eye contact, and I fall deep into ...

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I became a nurse at the age of 23. I was pregnant with my first son and dove into nursing headfirst, accepting a job in the pediatric ICU of the hospital where I worked. I still remember the call when I received the job offer. I hung up and jumped up and down, screaming in excitement. I couldn’t believe that I got my dream job, the job that wove my ...

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Matt was 40, my sister’s age. He was training for a marathon and trying to talk his many friends into joining. He lay in bed with his three-year-old son every night to help him fall asleep. It’s hard to sleep train a toddler with a newborn to nurture at the same time, but he loved spending this time with his two kids and being the dad everyone counted on. Matt’s best ...

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Florence Nightingale was among the first nurses who started wearing a nurse’s cap. The cap was derived by nuns and represented those caring for the sick. Hair was neatly tightened into a bun and covered by the cap. Back then becoming a nurse was typically seen as a female profession, but men were allowed to become nurses too. In 1930, only one percent of RNs nationwide were male. Growing up in the 1950s ...

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