American College of Physicians: Internal Medicine — Doctors for Adults ®

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Letters

From the March ACP Observer, copyright © 2006 by the American College of Physicians.

Care coordination codes

Thanks as usual for an informative article on coding. ("The New Year brings more changes to CPT/EM codes," January-February ACP Observer.) I have a question, however, about the information.

The authors write that physicians should "[u]se the new 99339-99400 codes to report care oversight provided to children and adults with special health needs. You should also use these codes when coordinating the medical care management with other medical and non-medical providers for patients with chronic medical conditions."

Does that mean care plan oversight codes can be used for coordinating care of patients with other providers, even if the patient is not under any home health care provider?

David C. Dugdale, ACP Member
Seattle

ACP's Washington office responds: The new CPT codes 99339 and 99340 are not to be used when a patient is under the care of a home health agency, enrolled in a hospice program, or a resident of a nursing facility. However, they may be used in all other cases in which care coordination for home care, rest home or assisted living facility is provided by the physician. Unfortunately, the Centers for Medicare and Medicaid Services (CMS) does not reimburse for these new codes, considering them to be bundled. Private payers often follow many CMS policies, but are not required to do so.

Listening to patients

After reading your recent physician profile, I didn't know whether to laugh or cry. ("Sometimes the trick is knowing when to keep quiet," January-February ACP Observer.)

I wanted to laugh because all good physicians know that taking a good history and picking up on subtle clues are vital to practicing good medicine. Telling internists to take a thorough history is like telling an editor to use "spellcheck".

I wanted to cry, however, because every practicing internist knows that practicing good medicine today is almost impossible. Getting the patient better is secondary to seeing enough patients and making sure that our "quality metrics" are in the highest percentile.

Instead of telling us something we should have learned in medical school, your publication should expose the plagues of managed care, pharmacy benefits managers, radiology benefits managers and pay for performance that are threatening our once honorable profession.

Christopher M. Boni, ACP Member
Livingston, N.J.

End-of-life care

You recently featured two pages of dense prose about the good management of chronic obstructive pulmonary disease. ("Special Focus," January-February ACP Observer.)

The feature managed to include poorly established advice about lung volume reduction surgery, nutritional interventions and indications for intensive care. Yet for a disease that is highly fatal when serious, the article did not even mention the need to inform the patient and family about the likelihood of fatality, to help them with planning, and to avoid suffocation at the end of life. To me, it reads like giving advice on obstetrics but not mentioning the baby.

We should do better. Such a feature would require only a short paragraph to attend to the need to plan ahead. Part of managing this disease is making sure that the patient and family are prepared for the exacerbation or complication that causes death, and to assure them that their dying will not be awful.

Joanne Lynn, MACP
Arlington, Va.

Editor's note: PIER has several modules devoted to advanced care planning and palliative care. Those modules are included in the "Ethics and Legal Issues" PIER index.

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