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Thursday, January 11, 2007

Letter to the Editor

I actually submitted this several years ago to the Journal of Urology as a satirical look at our system. It was not even rejected, but mearly ignored. What do you think?

Dear Editor,
Please consider the following manuscript for publication in the Journal of Urology.


606.0 and 608.30 in a 41 year old man status post-49505-50 with 49568.

Dr Richard Schoor MD
Private Practice
NY

The following case illustrates the importance of merging good clinical knowledge with sound knowledge of international classification of diseases, 9th edition (ICD-9), and current procedural terminology (CPT).

Case report: A 41-year-old man was referred from another provider for the evaluation of 606.1. The patient underwent an out-of-network 99244 at our office. An 81000 and 87088, authorized to be performed in our office, were negative. Additional blood tests, 83001, 83002, 84146, and 84403 were sent to a participating laboratory facility and were in the normal range. Multiple 89310s revealed 606.0. 76870 and 76872 were performed and were normal. A 99213 was then undertaken with the patient and the provider and the patient was counseled by the provider to undergo a 55110, 55300-rt, 55300-lt-50, 74440, 54500-rt, 54500-lt-50 with 89264 and 49568-52, of course, all under 69999.

After pre-certification and multiple letters of medical necessity, the patient underwent the above procedure. At the time of surgery, he was noted to have a normal 55400-lt and a successful 89264 was performed. However, the 55400-rt appeared to have suffered a 608.30, probably from damage induced by the 49505 with 49568. We attempted a 49505, but had to add the modifier –52 because of a dense 998.4 that prevented from us from achieving the level of complexity necessary to avoid modifier –52. The patient recovered uneventfully and was doing well at the first 99024.

Payment was denied for all but the 55400-50, or $373.26.

Discussion:
Urology and medical coding are both complex endeavors. We feel that adding routine ICD-9 and CPT terminology to standard published case reports and presentations would aid urologists in mastering optimal coding. In addition, if all case reports in all journals were written in the above format, it would serve to minimize the number of words per article, which in turn would free up urologists’ time to learn coding.

How did we get ourselves into this mess!
Sincerely,
Richard Schoor MD