In order to get paid for what I do, I must use two codes (to oversimplify): a "CPT" code and an "ICD10" code. The first is "what i did", the second is "why".
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BUT...not all "why" codes are legit according to Medicare/Blue Cross, etc. So e.g. my patient scrapes her arm and comes in for me to take a look. I could bill "S51" (open wound of elbow and forearm) but I won't get paid...so...
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i change it to s51.002 "unspecified open wound of left elbow"...nope. Still not specific enough. Finally I settle on S51.002A, "unspecified open wound of left elbow, initial encounter". Pretty damn specific, right? Well..
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...bill gets rejected again as not specific enough, so now I try again with S51.012A "Laceration without foreign body of left elbow, initial encounter".
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I could have seen two patients in the time it took to deal with that bullshit.
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But that's just the "why" code. The "what" code (CPT) is how I get paid. It's based on documentation, and tradtionally, docs use a SOAP note (Subjective, objective, assessment and plan) which gives the most succinct info to help patient.
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...and to make it even more insane, here is how to decide which of those columns applies:pic.twitter.com/sLyKsozToG
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and if you do it wrong, it's not considered a simple mistake, it's considered an intentional attempt to defraud insurance companies. So most doctors end up "undercoding".
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