To the editor:
I agree with the AAFP News Now story, "Academy Calls on Health Plans to Quit Bundling Certain CPT Codes," that the bundling of physical exam codes with office visit codes is completely unfair.
The practice of bundling a preventive-care visit with a problem-oriented evaluation and management service particularly discriminates against family physicians. My experience with UnitedHealthcare has been a "zeroing out" of almost everything that is billed with a physical. Another insurance company tactic is to offer patients a free annual physical, and then apply everything that is billed with the physical to the patient's deductible.
This strategy pits the patient against the doctor. The patient believes that he or she is entitled to discuss all of his or her problems at the "free" physical exam. Once my staff explains to the patient that this is not true, the doctor-patient relationship is tarnished.
I've seen patients walk out over such misunderstandings.
Insurance companies must accept the fact that one or two substantial problems will generally be discussed during a patient's annual physical exam. My solution is a 50 percent increase in all physical exam code reimbursements. Because of the added work performed during a well-woman exam, it should be a separate code reimbursed at over $100 and unbundled from any physical exam code.
Under my proposal, family physicians could do a well-woman exam and a full physical for a reasonable reimbursement rate of around $300. This fee would fairly compensate the family physician for his or her time.
Steven Sapsowitz, M.D.
Spring, Texas
