To the Editor:
In Dr. Carole Guillaume's article “Coding and Documentation Made Easier” (April 1998), she correctly writes that, in spite of level 4 (or even 5) history taking and decision making, the ultimate code for a new patient visit is dictated by the lowest level of the three patient-visit components: history, physical exam and decision making. Because most family physicians will neither perform nor document the mandated 18 elements of the physical exam to qualify for a comprehensive visit, the new patient office visit will rarely, if ever, qualify as anything more than a 99203. In the case described by Dr. Guillaume, the ultimate coding level was 99202!
In essence, family physicians are penalized for focusing their energies on key components of the patient's history or aspects of decision making, rather than simply going through the motions of performing (and documenting) elements of the physical examination that are not relevant to the patient's care!
What do patients complain about more: “My doctor never listens to me” or “My doctor forgot to palpate my apical pulse”?
It is time for all physicians to join ranks in combating stupidity on the part of those who would force us to shift our focus from the care of patients to an obsession with coding, as well-outlined in Dr. Guillaume's tear-out coding reference. If I were teaching residents again, I would encourage them to throw away their coding references and spend more time listening to and thinking about their many interesting patients — and documenting their findings.