Imagine If Coding Modifiers Benefited You

When I sit down overa cup of coffeewith my surgeonfriend, Joe Kutter,we occasionally getto talking about some of the things thatannoy us about the practice of medicinetoday. The following is a recent conversationbetween him and me:

Dr. Kutter:

Lou, I had a bad week.My office made me attend one of thosecoding seminars. They said that I didn'tunderstand coding, and I was leavingthousands of dollars "on the table."The whole ordeal was frustrating. Iunderstand assigning a number to allthe available procedures in order tohave accurate data reporting, but I justcan't understand why I have to add amodifier to signify whether the surgeryis part of a second procedure, whetherit's being done on the left side or theright side, whether it's the second timeI've done the same procedure, orwhether I did it on February 29 of aleap year. It is absurd. None of thataffects how I get paid, and I object tofilling out information just becausesome insurance flunky is compulsiveabout collecting data.

Dr. Constan:

I agree. What we reallyneed are modifiers that mean somethingto us—modifiers that representthe times when we do extra work andshould be paid more. For example, weneed a modifier for the patient whoasks a lot of questions about somethingthey read on the Internet, or thepatient who saw a television ad tellingthem to "talk to your doctor about thismedicine." I'd gladly use a code andmodifier for that.

Dr. Kutter:

Exactly. I could use acode for obese surgical patients;they're very difficult operations. Theyare physically draining and fraughtwith complications. I should get paidmore per pound.

Dr. Constan:

And I need one forpatients who bring in a relative and askme to "just take a second and look atBill's throat—it's been hurting today."

Dr. Kutter:

And I would love a modifierfor surgery on plaintiff's attorneys.They're intimidating because you haveto worry about everything you say ordo to them—or you know they'll sue.Even worse, you have to go to counselingafterward when you realize you'vesaved their life, only for them to preyon your colleagues. Counseling isexpensive these days.

Dr. Constan:

And how about amodifier for the patient who does an"oh, by the way" after you've completedyour visit and have your hand onthe doorknob? I ought to get paidmore for that.

Dr. Kutter:

I agree, Lou, and Ideserve a modifier to indicate that I dida particularly brilliant job during surgery.For times when every stitch is perfect,every cut is at just the properplace, and there are no significantbleeders. I would save on OR costs,because the patient gets better quicker—shouldn't I get rewarded for that?

Dr. Constan:

Certainly. And Ishould get more for taking care of oneof my neurotic, compulsive patientswith "falling hand syndrome."

Dr. Kutter:

Well, this has been funLou, but it's hopeless. Insurance companieswould never go for a schemelike that—no matter how logical. Itwould take years of lobbying, politicalpressure, bribery, and coercion, andthen they would deny us just for spite.

We didn't know it, but Joe's 13-year-old son Irving had been eavesdroppingon our conversation. I knewthat he was a computer geek, but whathe said next surprised me.

Irving Kutter:

Dad, why don't youlet me help? Give me the codes and thenames of the insurance companies, andI'll fix it.

Dr. Kutter:

Thanks anyway, son, butyou don't know who you're up against.We have precious little leverage withthose guys. Why do you think you canpersuade them when we never could?

Irving Kutter:

Who said I wantedto persuade them? I'll just downloadyour additional codes into their billingsoftware. They'll never knowwhat hit them.

Dr. Kutter:

Can you do that?

Irving Kutter:

Dad, you're so naive.We computer nerds learn that kind ofstuff when we're just out of diapers.Everyone in my class has hacked into abig company's computer. How elsecould we learn?

Dr. Constan:

Joe, what do youthink, are we trying to earn a living thehard way by practicing medicine?

Louis L. Constan, a family practice physicianin Saginaw, Mich, is the editor of theSaginaw County Medical Society Bulletinand Michigan Family Practice. He welcomesquestions or comments at 3350 ShattuckRoad, Saginaw, MI 48603, 989-792-1899, or louisconstan@hotmail.com.