Billing and coding are squeezing what must come first -- patient care

LETTER — Posted Jan. 12, 2004

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Regarding "Primary care troubled by coding errors" (Article, Dec. 8, 2003) and "Framing History" (Article, Dec. 8, 2003):

The recent article on coding error rates describes the difficulties primary care physicians are having in using correct coding for visits, the troubles coders are having agreeing on appropriate coding for visits, and the concern CMS has over paying for improperly coded visits. Meanwhile, the article in the same issue describes how the Burns Archive documents that, in the words of its founder, "the reason death has been removed from everyday life is because of medicine."

Sadly, while medicine has made great strides in relieving suffering, fighting disease and enhancing quality of life, we are spending more and more time and energy worrying about using the right coding numbers and descriptions to justify our work.

Yes, medical professionals must be able to bill appropriately and be paid appropriately for their services, whether payment comes from patients or third parties, but the fundamental issue that must drive medicine is patient care. Medicine is not about coding numbers -- medicine is about taking care of people. If our billing and payment system is so problematic that we must spend endless resources trying to fine-tune an inadequate system, then the billing and payment system should be replaced. Trying to shape medicine so that it fits the billing and payment system is putting the cart before the horse. Medicine is about patient care, and all other concerns must serve that end.

William Cayley Jr., MD, Augusta, Wis.

Note: This item originally appeared at http://www.ama-assn.org/amednews/2004/01/12/edlt0112.htm.

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