Thursday, October 9, 2008
A Tale of Two Vertebral Fractures
Dr. A saw the patient for a simple office visit and billed a 99213 (mid level visit) and spent 15 minutes with the patient.
Dr. A spent 30 minutes reviewing films, talking with radiologists, and organizing Mrs. Jones' care. This time was not compensated for
Mrs. Jones' cost to our medical system: 1 office visit, 1 xray, 1 MRI, costs associated with vertebroplasty (including outpatient interventional radiology consultation).
Alternatively Mrs. Jones walks in to see Dr. B with the same problem. Dr B is not as well trained, not as well informed, or doesn't have enough time. He takes a history and examines the patient. He diagnosis osteoarthritis of the spine and sends Mrs. Jones home with vicodin. Over the next few days Mrs. Jones' pain becomes excruciating. Furthermore more she is constipated. She calls Dr B for advice. He does not have enough time to see her so he sends her to the ER. Mrs. Jones has an xray in the ER that shows vertebral fracture (hospital day 1). She is admitted to Dr B's service. Dr B orders an MRI and gets the result later the next day Hospital day 2). He calls the interventional radiologist. The radiologist sees the patient the next day (hospital day 3)and sets her up for a vertebroplasty the following day (hospital day 4). Mrs. Jones is discharged after post op observation the next day (hospital day 5) with good pain control. Here's how it breaks down...
Dr. B saw the patient in the office and billed a 99213 but then admitted the patient to the hospital billing a 99223 for admission, 99233 x 3 for follow up days, and then a 99239 for discharge.
Mrs. Jones cost to our medical system: 1 office visit, 5 inpatient visits from Dr. B, 1 ER physician charges, 1 inpatient consultation from interventional radiology, 1 xray, 1 MRI, 5 days worth of hospitalization, costs associated with vertebroplasty.
Who benefits (IE MAKES MORE MONEY) from our current medical system: Dr. B, the interventional radiologist (in either scenario), ER physicians, The hospital
Who gets the short end of the straw: Mrs. Jones, Dr. A (good primary care physicians)
I have seen this soo often. Poor doctoring leads to increased costs across the board and increased revenues for those who deserve it least.
Posted by Jordan Grumet at 9:54 AM