Letters

Coding & documentation: No harder than biochemistry

To the Editor:

You recently quoted a study which concluded that "the complexity of the CPT guidelines and physicians' limited coding training accounted for the substantial rate of coding errors" [Monitor, September 2001, page 25].

As a "retired" physician with a second career in coaching physicians in documentation and compliance, I take exception to the comment that the CPT rules are complex. Anyone who passed biochemistry can master the documentation guidelines for evaluation and management (E/M) services in one to two weeks with simple aids such as those previously published in FPM and/or with personal coaching.

The article also stated that physicians' limited coding training accounts for the error rate found in the study. I maintain that we aren't coders, but we are documenters. With appropriate documentation, we can demonstrate the value we provide to our patients and receive proper reimbursement. The problem I have seen after auditing thousands of my colleagues' records is that we are poor documenters. That is the reason for our errors.

Let's stop whining and learn the rules of the game. They are relatively simple. Only by knowing the rules and following them will we be winners!

Herb Weinman, MD
Dallas, Pa.

Dictation during patient visit: Tried it, liked it

To the Editor:

Thank you for "Seven Reasons to Dictate in the Presence of Your Patients" [September 2001, page 37]. I had been toying with the idea of dictating in the room with patients ever since I saw the orthopedic specialists doing it during my residency.

I tried it and liked it so much that I will continue it indefinitely. Many of the benefits mentioned in the article have already materialized. In addition, I've noticed one benefit that was not mentioned in the article: privacy. I no longer have to worry who is listening as I stand at my station or duck around the corner to dictate sensitive information.

Douglas R. Morrissey, MD
Lititz, Pa.

Focused residency training key to future of specialty

To the Editor:

I read "Is It Time to Re-examine Family Practice?" [September 2001, page 43] and want to thank you for addressing this important subject. As a recent graduate, I see improving family practice residency training somewhere at the top of the list of things that must be done to secure the future of our specialty. Defining our specialty requires far more than advertising. Done correctly, it will pay huge dividends in making our role clear to the public, HMOs and other specialties. Here are several ideas that would improve residency training by helping to narrow and further define our competencies:

Some rotations, like surgery during the second post-graduate year, should be sacrificed. Others, like community medicine, while having some important potential, do not provide specific training for future practice. The core curriculum guides could use more specifics and more detail. This would naturally lead to a more structured and defined certification/recertification exam process. I propose we graduate with competency in primary internal medicine (inpatient/hospitalist and ambulatory), pediatrics, obstetrics/gynecology and geriatrics as the core. These core areas are a challenge to manage as experts, but I believe they can be handled comprehensively with the emphasis on primary care treatment and appropriate consult. I think other areas force us to disperse too much. Electives should provide needed flexibility.

I'd like to see the AAFP and the American Board of Family Practice form committees for each of the core areas I've mentioned to maintain up-to-date guidance. (The AAFP's Advanced Life Support in Obstetrics (ALSO) course is a shining example of this idea.) We also need to implement clear standards of competency for procedures (e.g., the minimum number of supervised procedures performed by a resident unassisted).

With such a package of competence, we can clearly demonstrate a need for physician-level primary medicine. No other specialty can do this. I think our future is bright as long as we can demonstrate our competence in primary care clearly and specifically.

Isaac Kim, MD
Fayetteville, N.C.

Corrections

The admit order for community-acquired pneumonia, one of the orders mentioned in the October 2001 issue ["30 Standardized Hospital Admission Orders," page 49] listed the wrong dosage of Zithromax. The dosage should be 250 mg, not 25 mg.

The November/December 2001 Practice Diary contained an editorial error. In the vignette titled "Networking" [page 50], the word echocardiogram was mistakenly replaced with the abbreviation ECG. We apologize to Dr. Brown for our mistake.

Copyright © 2002 by the American Academy of Family Physicians.
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