Thanks Jon for the thoughts!
Much of what you say, I do not disagree with. Certainly the implication that we are pawns in a much larger game. Nevertheless, I feel the need to comply with accurate and specific coding and our software does not allow for it currently.
You are right, in my example I would not include hypertension because it bears no relevance to the clinical circumstance. But HIV does as it effects the immune system and the warts and the dermatitis may be related thereto.
As to 4 (ridiculous) eyelids: that is the code. Dermatologists are involved with eyelid dermatitis, whether it be allergic or irritant and the code specifies precisely. I simply try to be as specific as I can, call me a wuss.
I dont think I have to remind any one of us that in the next year or two, our payments are going to be based upon an entirely different system. And that system will "look-back" at the nature of each of our practices to determine our values. I would argue that if you care about your future income, you would want to develop statistics that accurately reflect all of the myriad diseases your patients have (up to 12 at least!)and that you take care of.
The other codes I've indicated obviously must be entered as they are codes I have shown would be billed for in the example.
So, yes, I understand we can often get away with things. But I sleep easier if I just play the game I am invited to, with the ball and bat they gave me, until I am out of the game.
