Notice that the title doesn’t say “can’t Help You.” It says “won’t.” There’s a big difference.
CPT codes are the stuff a doctor’s practice is made from. I know — you thought patients were the basis for a physician practice, but no, CPT codes are more important than patients — even though I can guarantee that most doctors wish that was not true.
CPT Codes, Current Procedural Terminology Codes, are all those little numbers that show up on the bill you are handed as you walk out of the doctor’s office. They are supposed to represent every type of task performed in medicine — from a basic check-up, to diagnosis, to administering a shot, to giving a medical test, to the levels of that test, to surgeries, to anything at all. They are developed by the AMA, the American Medical Association, and are intended to be the standard by which all doctors get paid, and all insurance reimburses. The codes are revised regularly, and new codes are developed by an editorial board that represents the membership of the AMA.
Among the most frustrated of patients I hear from are those who can’t get diagnosed. There can be a number of reasons for not getting a diagnosis, but one of the big problems is that patients can’t find one central person to review all the evidence. They are sent from specialist to specialist, each looks at his own tests and results, but they don’t look at results from other doctors, except maybe the one who referred the patient.
I call this daisy-chaining. Each doctor represents a link to the answer. Each link might look at the information from the link it is connected to. But none of those links review information from links they are not directly connected to.
So what does that have to do with CPT codes? Plenty. Because the reason they won’t look at the other records is because there is no code for doing so — therefore — there is no way they can get paid (reimbursed by Medicare or insurance) to look at the big picture for a patient.
Why not? I have theories, and they all relate to money, of course. The AMA represents the doctors. One would think that if doctors wanted to do this kind of big picture diagnosing, or review of other’s notes and reports, then the AMA would develop a code for it, right? So theory #1 is that doctors don’t want to be doing so. They don’t want to be responsible for that particular task.
Theory #2 is that why would the AMA waste its time if insurance won’t cover the cost anyway? And that’s actually the root of today’s blog. A review of the new codes for 2008 shows that codes have now been developed for doctors who take phone calls or email from patients. However, the report includes a caveat that says Medicare and insurance companies won’t be reimbursing for them anyway.
So that explains why your doctor won’t do what you wish he would do — take a comprehensive look at all your health challenges, and help you get diagnosed even after seeing a slew of specialists. They wish they could — but they can’t. If they can’t get paid, they can’t stay in business. If they aren’t in business, then what good does it do for anyone?
I do give a bit of credit to the AMA for at least giving their new codes a shot — it’s a start. Many more are needed.
But what’s really needed is someone to kick the payers in the backside. They work for US, afterall — we pay taxes and we pay premiums. So why aren’t they held accountable to reimburse for all those codes?
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Trisha,
Two comments.
First, the doctor who ought to be doing this (making the diagnosis when the diagnosis is not clear) is the general internist. It’s what they spend 3 – 4 years training to do. But once they get out into primary care practice, they find they can spend only 7.5 minutes per patient visit, or else they can’t afford to stay in practice. So – difficult cognitive problems are immediately referred to a specialist. And deciding which specialist (when the diagnosis is not clear) is necessarily a guess. Specialists may end up telling you “Sorry, it’s not my organ that’s causing the problem,” but they’ll only do that after they’ve performed whichever procedure(s) they always perform, on everybody, no matter what.
Second, in my view, the lack of appropriate billing codes for cogitation and communication is a symptom of the problem, not the root of the problem. The root is that doctors (especially primary care doctors) have allowed themselves to be coerced into a position where government bureaucrats and insurance administrators (who each respond to their own byzantine sets of prompts) are able to determine what docs do and how they do it.
I believe, unfortunately, that it has become extremely difficult – approaching impossible – for conscientious internists to practice excellent medicine under what has become the mainstream healthcare system. Alternate forms of medical practice, entirely outside the mainstream system, may be the only viable alternative for these doctors.
DrRich