Hi all,

This is sort of hard for me to write. It is more or less a followup to this thread

http://amazingcharts.com/ub/ubbthreads.php/topics/38424/Maximizing_billing#Post38424

I would like to thank all who responded to that. EMUniversity has lots of useful info, my takehome is that I was doing way too much charting to justify a 99214. I think I'm getting comfortable coding more 99214s, with briefer (but adequate) charting.

But the whole process has caused much soul searching. This was largely provoked by 2 job offers, one from a Community Health Center in which I had worked in the past, the other from a very for-profit group that is being established. Both were for quite a bit more money than I am now making.

The process of considering these made me really ask why we do the things we do. And, while trying to decide that, I realized that I had developed a really really crummy attitude toward practice. Sort of a hopeless/helpless/it will never get better, only get worse/whats the point attitude (most of you are now reaching to rx the Lexapro, I know....) Not having the hassles of payroll, practice management, etc....

But when I really thought of giving up solo Family Medicine, something clicked.

Why do we do what we do? Because we do it well. Really, really well. Anyone who has been in practice a while knows what I mean. In terms of getting patients well, and keeping patients well, we are top notch. Can a doc-in-a-box, or an ER, or a large group where the patient sees a different provider each time do what we do? Can a specialist do what we do? Can a hospital system do what we do? Overall we save the system lots of money, avoiding unnecessary testing, avoiding hospitalizations, and so forth. And we really keep patients healthier.

This is worth keeping, and fighting for. A spark in me has been reignited. I am not going to feel guilty about coding mostly 99214s, if the documentation supports it, then we deserve it. If we can get paid for both an annual, and 99213/99214 on the same visit, so much the better.

But I think I will also value what we do a little more, too. Just that internal sense of "What I do is really important" has been recharged.

Finally, I would like once again to thank all the members of this board. This is a great group, extremely knowledgable, but equally caring. When I was considering other practice settings, one of the questions was whether I was willing to give up AC and this board. That would have been really hard, too.

So thanks again to all. And go Steelers! (Sorry JBS and DCubed.)

Gene


Gene Nallin MD solo family practice with one PA Cumberland, Md