Fam Pract Manag. 2010 Mar-Apr;17(2):48.
- Use a cell phone camera to document biopsy sites
- Streamline your annual physical process
- Handling prescription change requests from PBMs
Use a cell phone camera to document biopsy sites
When I biopsy a lesion and don't excise the residual myself (typically a central face basal cell carcinoma that requires Mohs surgery), it may be two or three weeks before the patient sees the surgeon. In that time the site may heal, making it difficult to tell where the abnormal tissue came from. To prevent this problem, I borrow the patient's cell phone camera after the biopsy and take pictures of the site (if the patient doesn't have a cell phone, an accompanying family member often does). Then, at the follow-up surgical appointment, if there's any question where the tissue came from, the patient can pull out the cell phone and show the picture.
Remind the patient not to erase the photos prematurely. Take at least two pictures with the camera: one close up and one wide view that shows facial landmarks.
Streamline your annual physical process
As a young physician, I was bored to tears by the ritual of the annual physical. History-taking was tedious and time consuming, and the yield was minimal. After a six-year flirtation with emergency medicine, I opened my own family medicine office, and I was determined to tame the tradition.
From the beginning, I assigned the history to a smart registered nurse who sorted out the problems and ordered appropriate labs in the patient's first visit (which I don't bill for). When I met the patient for a return visit, I already had the goods. We jumped right into problem solving, education, encouragement, medication adjustment and projections for further testing. The physical exam itself, as every experienced physician knows, takes only a few minutes. I ask for these “database physicals” only once every five years up to age 50, and every two years thereafter. This schedule has proven to be more than adequate to flush out preventable disease and handle problems proactively. The time involved in these exams may be a loss leader, but it is more than counterbalanced by the revenue from routine follow-up care and the professional satisfaction of providing quality care and proving that family medicine works. I always do a “postmortem” when a patient shows up at the hospital with a preventable disaster. Three times out of four the patient is someone who has ignored my repeated promptings to schedule a database physical.
Handling prescription change requests from PBMs
My practice receives numerous requests from pharmacy benefit managers (PBMs) to switch my patients to different prescription drugs. What's the best way to handle these requests?
For the most part, PBMs want to ensure that patients receive the most clinically appropriate yet cost-effective drugs available. If switching drugs would provide a clinical or financial benefit for your patient, you could handle the request in one of several ways:
Place the request in the patient's chart to review at the next visit,
Consult with the patient over the phone about changing to another prescription drug,
Contact the patient about scheduling an office visit to discuss the potential change.
Although there is no CPT code specifically for discussing prescription drug changes with a patient, it may be medically necessary to determine the patient's current health status, review current medications and prior medication history, and discuss patient concerns related to the possible change. These services, provided face to face, could be billed with an established patient office visit code.
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