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Healthcare’s coding system: no pain, no gain for docs

Dr. Rob, the author of “Musings of a Distractible Mind,” is really good at explaining difficult concepts. If you haven’t read his description of healthcare’s coding system, you should take a peek. It explains why documenting care is so complicated, how doctors try to “game the system” and what happens to them if they do.

Here’s a small excerpt:

“You see, what you get paid for an office visit is not based on what you do at that visit, it is based on what you document. The more you can document, the higher you can bill… There are several responses to this situation by physicians:

· Undercode to avoid the accusation of fraud

· Use EMR to document more and bill at a more appropriate level

· Code at the higher level without documenting higher and risk audit, jail, etc.

· Stop accepting insurance and just accept cash up front based on your own criteria

· Do other things besides office visits – such as surgical procedures, labs, x-rays, or other procedures that pay much better than the office visit. The pay for EKG with interpretation is nearly as high as that of the decision making that the physician makes that may save the life of the patient.”

So next time your doctor is delayed in seeing you… she’s probably trying to document all the right check boxes and codes for the last patient she treated!This post originally appeared on Dr. Val’s blog at

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