Bridles and Bits


“You coded a 99213 on this patient. The documentation level indicates it should have been a 99214….”

“Right. She was self pay so I down coded a smidge.”

“That is why we have cash pay discounts, so you don’t have to do that.” The woman scowled at me from the other side of my desk.

“She is a single mom and needs that money for school clothes. See, I wrote that in the History of Present Illness section…”

“You need to recode that,” she interrupted. “Additionally, you did not charge for the pulse ox reading.”

“I felt guilty charging her $14 to slap an electrode on her finger for 20 seconds.”

“You need to add that charge, too.”

“Is that all?”

“Here is another one, similar issue…”

Eventually she left. I piled the paperwork into the shred bin and authorized my office manager to keep the charges where they were without adjustment. I had failed my coding audit. Barely. Meh. The woman would be back in another six months and we would do this all over again…


103 thoughts on “Bridles and Bits

    • Hey, Hey, Hey! Go easy there Elyse – not all MBA’s are bad some run NGO’s and charity organizations and some do pro bono work. The problem is the Executive who give the MBA’s the orders – they want bigger bonuses and happier shareholders.

      Liked by 2 people

      • No, not all of them are bad. But I think many hospitals and healthcare companies have been taken over by folks who believe more in the bottom line than in healthcare. And that has contributed immensely to the rising costs.

        Liked by 1 person

      • One if the reasons we have been told this has to be done is that any company (or the government) can come in and audit and say, “why are you discounting such and such?” And then can demand that ALL patients are given the same deal….

        Liked by 1 person

      • But those regulations likely govern larger organizations and hospitals. That’s generally true of mod regulations — the larger the entity the more burdensome regulations are. It could be different even with smaller doctors offices though. Regulations are remarkably similar across the board. One of my old bosses used to say; Regs is regs.

        Liked by 1 person

  1. In circumstances like these do you ever want to look at the other person, just doing their ridiculous job for a (hopefully) livable wage, and LAUGH UPROARIOUSLY in the hopes that you both will have a better day.

    Liked by 1 person

  2. Government audits like that drive me nuts Victo. In transportation we were subject to Federal Transport department audits for training and documentation as well as Provincial Transport audits of hours of service for the drivers. The worst of it was that none of them would leave until they found something to write us up for – they had to justify their visit to their superiors. We operated the majority of our fuel tankers out of Ottawa and our head office was in New Liskeard, Ontario.- about 300 miles away. We were a separate incorporated company in Ottawa wholly owned by our head office. All our vehicle registration and maintenance records were kept at our head office – they owned the trucks and held the operating authority.. The provincial regulators audited us and said that because we were a separate provincially registered company, we were required by law to keep all our records in our Ottawa Office, so we moved them all here. About two months later we were audited by the Feds and they fined us because they said that our operating authority was federal, and that all our records had to be at the head office (they held the operating authority). So we moved all our records back to New Liskeard. Just waiting to see who audits next. Ha!

    Liked by 1 person

  3. Thank heavens I’m not self-pay, but I think having insurance drives the bills up. When I broke my foot, the ER PA accidentally ordered an ankle x-ray. The x-ray tech took the film, but then asked me what my complaint was – foot pain, not ankle pain. The x-ray tech called the ER, and sure enough, a foot x-ray was then ordered.

    When the bill came, I noted charges for both an ankle x-ray and a foot x-ray. I called to complain, because the ankle x-ray was done based on an error by the ER PA. I expected the hospital to drop the charge for the ankle x-ray. The billing clerk said, “Well they did both x-rays, right? And you have insurance, right? I’m charging for both x-rays.” Ugh.

    Liked by 1 person

  4. I miss the days when you could just break off a piece of gold from your jousting trophy, give it to the doc, and that would be the payment, finished!

    (10 points to whoever can name the movie that’s from!) πŸ™‚

    Liked by 1 person

  5. You friggin renegade….. lolol We are now having to double coding to get used to the new IDC-10…. its awful. we actually have an outside agency who checks our coding. Then, when they disagree, they try to order the clinician to change it. Wait a minute who is actually assessing the patient here? And then…please, don’t ever up-code….. what a mess.

    Liked by 1 person

  6. If the money measure is so thoroughly applied for cost audits and cost control, are you also allowed to claim a fee for the life you could have saved in the period of the audit? You are not the accountant, you are the physician who’s main task is to help patients.

    That is an interesting question for everyone involved, financially especially the insurance companies and legal consultants. Prepare for a catch 22…

    Liked by 1 person

  7. Unbelievable! $14 for a pulse ox? And just the idea of coding audits… I guess I could see it being a problem is you were over billing instead of under billing. But really, what’s the harm in under billing, except to you?

    Liked by 1 person

  8. the simplicities of insurance companies and their mandated codes for nothing more than to determine price for everything. Am I too cynical or have I just summarized the whole horrid insurance practice in a single sentence before having my coffee? Maybe neither, maybe both, I don’t know.

    Liked by 1 person

  9. Pingback: My Article Read (9-4-2015) | My Daily Musing

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