Sky Insurance

The last seven days have brought forth an interesting mix of stimuli to me.

I attended a coding seminar in Las Vegas, flying out last Saturday and returning on a night flight on Tuesday. As the conference industry has expanded in Las Vegas, I'm always struck by the juxtaposition of professional conference attendees and degenerate gamblers on display in any casino in the city at any given time. After absorbing three days of industry knowledge in this environment, it slowly became harder to decide whether the constant ringing in my head was coming from the inundation of sudden knowledge or from the cornucopia of slot machines.

The cab ride home from the airport was interesting Tuesday night. Apparently, the addition of GPS in modern taxis has not increased the sense of direction of cab drivers at nearly a comparable level to skyrocketing cab fares. I had $12 in my pocket, and thanks to the circuitous route taken by the cab driver, the fare was up to $16 and I was still ten blocks from my house. Thankfully, ten blocks from my house is where my bank's ATM is located. I took some money out, paid the driver begrudgingly for her impeccable navigational skills, and walked the last 10 blocks in 14-degree weather without a coat while carrying my bag. To all the muggers of the world, this is my way of telling you that you missed your chance for an easy mark. After 4 blocks of sub-Arctic marching, I could have been knocked out with a bouquet of Gerber daisies.

Over the last few days upon my arrival at home, I have been reading a biography of the band XTC, whose lead singer suffered a nervous breakdown from excessive touring. I briefly felt his pain in the hours after the walk home. As I read this story, my 3-year-old was pretending to be Batman, complete with cape. He does this by running back and forth between the kitchen and living room of my house. To finish out my week, I arrived at my desk this morning and was told it was time to relocate within the office, along with about 15 of my coworkers. I have gone from the spacious cubicle enjoyed while creating previous posts here to a work area that faces a blank wall. All I can think is "At last the bells finally stop ringing; where are my crayons?"

In this week of over-stimulation, it seems a good time to look at the equally chaotic reimbursement landscape now that Medicare has ceased payment on consultation codes. Rather than panic, I'd like to suggest an alternate route for specialty physicians who now face a decline in revenue due to the elimination of these codes for Medicare billing. Rather than pining for payment opportunities that have disappeared for good, now is the perfect time to give a second look at the documentation you create for the E/M services that still exist.

I ask the physician who may be reading this to pull out one piece of documentation from a random patient they have seen today and look it over. Does the documentation give a useful, reimbursable and defensible narrative centered around the patient's chief complaint? Is it a collection of sentences telling a story, or a morass of acronyms like "C/O", "WNL" and "Ox3"? Could this documentation be better based on the code chosen? Conversely, could it have been reimbursed at a higher level had you correctly documented the service performed on behalf of the patient?

If physicians can look at the documentation for their E/M services and come to the conclusion that to the best of their ability, they have accurately captured the services performed in a narrative format, and that the clinical language of the chart has a direct correlation to the billing language chosen (the reported CPT code), the perception of the amount lost as a result of a consultation code not being available suddenly changes. While medical necessity remains the main driver in the selection of a CPT code, an opportunity may exist for financial stability with a simple review of a medical record. With consultations billed to Medicare now a thing of the past, there's no time like like the present to take another look.