Posts Tagged CPT

Advance Care Planning — one more CPT code

cptbookThe AMA has 7,800 codes for all types of medical services.  Discussion of end-of-life care has been considered part of routine primary care.  Now, the medical-industrial-complex wants another fee for the service of discussing this topic.

The service in question is “Advance Care Planning“.  Certainly, a good idea — a health care provider should be talking with patients about end of life issues.  We all die, that seems obvious, but someone should ask: “when it does happen where do you want to be, who would you like to be there, and have you told someone about your wishes for medical care at the end?

Virtually anybody can ask those simple questions.  Sure, getting up the nerve to ask the questions is hard for family members.  And, sometimes there is no family to discuss the questions or the answers.  Like other issues of health care, the primary care provider should broach the questions and record the answers and facilitate discussions with the people close to the patient.  It’s not a question that needs repeating at every visit, but periodically as conditions change.    Is the discussion important?  Absolutely.  Soap operas are not where the answers exist.

There is an undercurrent of distrust.  The distrust is because the medical profession seems so motivated by profit they may do unnecessary treatments when death is near.  Thus, to avoid unnecessary treatment a person must clearly state what medical services are wanted at the end of life.

The issue is clouded by the huge shift in the doctor-patient-relationship over the past 10 years.  The doctor who might see the patient in the primary care outpatient clinic is not the one who will see the patient at the care center, or the oncology clinic or be the admitting physician at the hospital.  Unless the patient, family and friends have a clear grasp on what the patient wants the information may be lost or be misrepresented.  It would be incorrect to think the medical record will be universally available — it’s not now and will probably not be that way for decades (if ever).

An equally difficult problem is the “grey area” between care that works and futile care.  “Is this the end?”   The care provider who is asked that question is really on the front line, not the primary care provider who discussed the issue 10 years before.

The elephant in the room is the cost of care.  And, the fact many people do not have the resources to pay tens of thousands of dollars a month for care when their income is just Social Security.  Very few people say “do everything”.  But, can a person with no resources actually say “do everything” and expect that to happen?

The bottom line:  the new CPT codes pay for something a primary care provider should already be doing so the additional cost is not needed.  If the discussion is not happening then it is a case of poor quality primary care.  Paying more never makes low quality care better, it just makes poor quality care more expensive.

An end-of-life discussion with a knowledgeable provider tends to set expectations in a reasonable range.  Satisfaction with medical care is often about meeting expectations, so this is important for the patient and the care providers.  It also should set expectations for friends and family — after the patient dies they are the ones who decide if expectations are met.

, , , , , ,

Leave a comment

Classification of Diseases — ICD-10


The International Classification of Diseases version 10 is called ICD-10.  Here is an example:  S06.5X9A    You can look this up on the CMS web site (ICD-10 Lookup) to find “Traumatic subdural hemorrhage with loss of consciousness of unspecified duration, initial encounter (that’s bleeding around the brain due to a blow to the head which the provider evaluated for the first time).

So, why is this important to you as a health care consumer?  Because the bills sent to insurance companies use these codes — if the code is wrong then insurance will reject the claim.  By looking up the code you will actually know the technical diagnosis made by your provider — something to add to your DIY medical record especially if it is a critical diagnosis in your situation.

The diagnosis codes are intended to force providers to be very specific about the conditions they treat.  The people who connect diagnosis to outcome find the codes very valuable — which in turn helps consumers know how providers perform.

The codes are not always seen by the consumer — they are transmitted on insurance claim forms.  In fact, insurance companies will refuse to tell you what diagnosis was used to bill services.  But, the codes often find their way into the medical record — as they should.

The ICD-10 code tells the diagnosis.  A companion code called Current Procedural Terminology (CPT code) tells what service was provided (like an office visit, or perhaps a brain surgery).  ICD codes are in the public domain but the CPT codes are produced by the American Medical Association and are copyrighted.

From a purely economic standpoint the CPT codes serve primarily to fractionate the health care market to maximize profit for providers.  It is helpful to know what service is provided but the CPT codes are blighted by meaningless detail.  And, they are hard for the consumer to decode because of the proprietary nature of the codes.  Many feel the CPT codes are part of the cause of high health care cost in the US.  They should be scrapped and replaced with some international standard.

Another site to look up ICD-10 codes:  click here.
The AMA site to look up CPT codes:  click here.

, , , ,

Leave a comment

Fee for Counseling Service — another CPT code

cptwowWow, you could have had a CPT code and $60.  While fee-for-service is widely excoriated for excessive cost what is CMS doing?  They want primary care providers or someone to have another fee-for-service.  The fee is for “counseling” about lung cancer CT screening and “counseling” about weight loss.  Both things that are currently part of an office visit with no additional CPT code — just good patient care.

Both topics could easily be covered on YouTube in several languages but NO — lets do this the old fashioned way and spend a zillion dollars for each provider to reinvent the discussion each time.   CMS:  don’t be so lazy — make the patient education video and tell primary care providers the URL!  And, update the video every 6 months.

The bottom line:

  • Lung Cancer CT Screening:
    • Don’t do it if the patient can’t have surgery
    • Don’t do it until the patient has 30 pk yrs accumulated (number of packs per day times number of years)
    • Don’t do it if the patient is less than 55 or over 80 years old.
    • Don’t do it if the patient quit smoking more than 15 years ago.
  • Weight-loss counseling:
    • Say in a loud voice “you weigh too much” then say “eat less”.  (that was not so hard!)
    • Doctors have been doing this for decades without sustained  results.
    • There are 20,000 books about diets to loose weight without sustained results.
    • This is not going to work — at least be honest.

Follow the money:  

Counseling fees for CT scans is an incentive to do the CT scans.   The primary care provider makes money, the x-ray office makes money and the radiologist makes money.  A better idea is to have the radiology office pay the primary care provider for the counseling out of CT revenue so this is a no-sum-gain.  Better yet — make it a provided service under an ACO plan!

Counseling fees for intensive weight-loss is an incentive for lots of repeat visits or a referral.  The Primary care provider makes money (and changes from a primary care provider to a specialty provider).  The incentive reduces the pool of available visits for primary care with little if any benefit to the vast majority of obese people.  A better idea is not to add another CPT code.  If the patient needs more time — make another appointment!

, , , , , ,

Leave a comment