First of all, congratulations on your selection as physician editor of The Rheumatologist. I wish you all of the best in this endeavor. If your future is anything like your first commentary regarding the U.S. vs. Canadian health systems, the journal has a bright future. Your comments were thoughtful, succinct, erudite, and captured past issues as well as potential paths for the future. Thank you for those insights and clarity.
Regarding the February “Coding Corner,” although I know that the upcoding was legitimized by the time spent (30 minutes), I have some philosophical concerns, especially because our business manager stresses that coding based on time can be a delicate issue. When was the patient last seen: a month ago, six months ago, two years ago? Some of the documentation was based on family history and review of systems (six separate areas). It is deliciously easy to bring forward these categories (from original questioning) into a current record with a click of a box—and giving the impression that all questions were truly asked. Pardon me for my suspicion, but this comes from a group with almost 10 years of EHR experience. Does the 30 minutes include the time to do the X-ray? And why was the X-ray done? The report indicates no change from a prior X-ray done “the previous visit.” I won’t ask why a complete urinalysis was done.
My issue is based on the honesty of it all, and the example as it is represented. In addition to being true to ourselves, we do have responsibility for costs (even if other subspecialties do not). Does this really and truly justify charging more? Even if it’s a few dollars difference, what message is being sent?
Paul Waytz, MD
Arthritis and Rheumatology Consultants