Point-Counterpoint: A Hospitalist and An Internist Argue Relative Value

Brian’s Note: Readers may know that, on this site and on Replace The RUC, I re-published the article below by the Happy Hospitalist, a physician intimate with coding and its craziness. His explanations of the system’s inconsistencies are lucid and compelling, as are his descriptions of how adhering to this system is overwhelmingly burdensome. Those of you who have read it before may want to scroll down to the content that follows and responds to it.

Then, last week, I received a long complaint from an orthopedic surgeon who appeared knowledgeable about coding, and who defended the RUC’s approach. He claimed that, properly understood, specialists make approximately the same as primary care physicians on an hourly basis. I am by no means a coding expert, but I responded that, while his argument may have some merit, the facts remain that specialists have made increasingly more over time than generalists who see many more patients. I thought there was a logical flaw in his approach.

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In the Eyes of Medicare, You’re a 99223


First published 11/26/07 on The Happy Hospitalist.

Want to know how doctors get paid?  What is a 99223?  What does that mean? Well. It means everything. And it means nothing. It is the vast land of numbered codes, the mystery of  CPT medical coding that every physician must grasp, or at least their office staff, in order to get payed for services provided. It is how doctors get paid to remain a viable business of providing health care.  It is called coding.  I’ll repeat simply:  It is how physicians get paid.

As much as I love coding (because I’m good at it, really good at it), it is a ridiculously difficult and arbitrary. So difficult and vague that often times audits by Medicare often result in multiple different opinions by Medicare themselves, by their auditors.

Continue reading “In the Eyes of Medicare, You’re a 99223”