See this section in previous issues concerning ICD 9 and CPT coding

The International Classification of Diseases is currently in its ninth edition and identifies 16,000 medical diseases or diagnosis. It is known as the ICD 9 and used by all physicians and surgeons. This is being up graded in the 10^th edition to 68,000 diseases and diagnosis in October 2015. It then will be known as the ICD 10 and all physicians and surgeons who bill Medicare, Medicaid, or any insurance plan will be required to use it

Current Procedural Terminology – CPT codes which include the Evaluation and Management Guidelines with descriptions for all medical and surgical procedures—are upgraded on an annual basis. These were discussed in this column in the previous issues of MedicalTuesday. This causes confusion in every specialty and many denials of payment for an inappropriate code. These denials will continue until the physician’s office staff sifts through the payment receipts and recognizes the error by lack of payment for a type of medical work done. Even then, it may be difficult to obtain a working code.

In our office we noted the lack of payment for pulmonary function tests. We thought that the diagnosis of asthma or emphysema would identify the disease and justify the procedure. After a number of months of doing PFTs free, our biller’s friend said you have to designate “wheezing” in addition to asthma or emphysema. Medicare was cross checking on a symptom or physical finding of a disease and wouldn’t accept the diagnosis alone. The Medicare bureaucrats didn’t think that doctors would come up with the correct diagnosis of a disease unless he/she also mentioned the symptom of the disease. But there are many symptoms of asthma or emphysema in addition to wheezing, such as shortness of breath, coughing,  with or without phlegm or purulent sputum, and others. Maybe the next edition will require other symptom.

With 68,000 new diagnostic codes, with each having a number of symptoms and findings, is this a new Medicare weapon against physicians? Is that why our practice association has warned us to have at least three months income in the bank before October 2015?

In this column, we have been warning our colleagues that we may have Armageddon in October 2015. We have also given a number of examples of our colleague who thought he was very diligent in his coding, until several years after the last ICD 9 or CPT codes were upgraded. Then he had a visit by CMS and a US Attorney and was told he made an error in “up-coding” which is a federal crime. Without an attorney present, he apologized, said he would use whatever code they said should be used. The US Attorney obtained a signature from the doctor admitting that he did use the code they said was incorrect. (Later in the trial, he had witnesses stating that he did use the appropriate code, was actually down coding, and thus saved CMS money. Thus by some experts testimony he had not committee a crime.)  After the signature, he was handcuffed and spent two years in jail. Of course, that doctor will never vote again, he lost his home paying attorneys after the fact rather than before the interview, and is a felon and will never practice medicine again. (The facts at the trial suggesting that no crime was committed made no difference in his outcome.)

There are numerous examples of high income surgeons having multi-million dollar fines and spending up to six years in prison. There are numerous examples that you will never hear about from your local, state medical societies or the AMA, which was a strong supporter of Obama and Obamacare. I’m told by those that should know that the leadership of the AMA was looking forward to being the chief negotiator for physicians in Obamacare just as the BMA is the chief negotiator for the NHS.

To keep in touch with all the hostilities toward physicians, you must join the AAPS, the Association of American Physicians and Surgeons. See below. Our attorney told us never respond to any medical legal matter, whether from Medicare, Medicaid, Medical Board, hospital board, HMO, IPA, Blue Cross-Blue Shield or any insurance carrier. Call her first and let her write the letter and provide all the legal response. She told us that Medicare, Medicaid, Medical Boards, Hospital Boards, HMOs, IPAs, Blue-Cross-Blue Shield or any insurance carrier is not and will never be your or any physician’s friend.

This became forcefully apparent to me. About six years ago when I went half time with a three office-day week, I moved further into suburban Carmichael. Since I still had a Carmichael address and phone, I thought this would be a simple address change.  However, Medicare threw every obstacle at me for seven solid months. They treated me as a medical student entering practice for the first time. Every form had to be redone several times to please them even though they were letter perfect and very neat. After seven months, my wife got on the phone to Medicare and pleaded with them that lack of income for seven months was very devastating to her. She received a promise that Medicare would promptly expedite payment and we got our first check after seven months the following week. It was not a check that we felt covered seven months of rebilling, but it was a check for one week’s income. But the checks did come weekly thereafter. However, we never got a check that would indicate back payment for the 28 weeks of no payment.

So on the day that the New ICD 10 is implemented and required, I will close my office and say goodbye to the practice of Medicine, the love of my life where I spent all my energies for 50 years. I don’t want to spend the last 10 or 20 years of my life in prison. Or even 22 months in prison, which is the shortest sentence I’ve found in the 30 years I’ve been observing government’s hostility towards doctors.  I will devote my energies to expanding this newsletter which now goes to six continents and 14 countries. This month we would like to thank the new MedicalTuesday subscribers from the US, UK, Canada, Chile, Japan, Korea, India, S. Africa and Germany. Welcome to all and thanks for joining us in our efforts for freedom in health care choice.

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Medical Gluttony thrives in Government and Health Insurance Programs.