Posted by: notdeaddinosaur | April 15, 2008

A Manner of Speaking

Scalpel said this:

Is billing for questionably-indicated procedures really any different than adding an unnecessary family or social history to increase one’s charges? I say no.

The Happy Hospitalist disagrees with him, and he is right (HH, that is.) Here is why:

Scalpel is correct in only the most technical manner of speaking. In the sense that anything you do (or document) that is not strictly necessary for diagnosing or managing the patient is “fraud” then yes, documenting a family history in a geriatric pneumonia patient is the same as a colonoscopy for bright red rectal bleeding in a teenager with visible hemorrhoids.

The case begins to fall apart when you explore the concept of risk/benefit analysis. The risk of taking a history is zero. No one’s colon was ever perforated by asking what their parents died of. No one ever suffered a pneumothorax from being asked if bleeding runs in the family. No matter how small the potential benefit of “history” vs. any procedure, you can’t beat zero. Therefore unnecessary (sorry — marginally useful) procedures can never be truly comparable to elements of a history.

HH and Scalpel agree that the central issue is that counting the elements of documentation to determine levels of payment is nonsense. It would be much more logical to simply pay for evaluation and management services on a straight time scale (like lawyers) rather than the ridiculous system in place today. Given the system that we are stuck with have, though, it goes without saying (sadly) than all players will take whatever steps they need to maximize income.

But for those padding their pockets with procedures to claim that we’re doing the same thing by recording “unnecessary” elements of a history is like the school bully pointing at the Chess Club president and saying, “You beat people every day too, you know!”

Only in a manner of speaking, Dude; only in a manner of speaking.


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