WhiteCoat

How Payments Affect Care

When an unconscious intoxicated multiple trauma patient was brought to the ED, we did a bunch of CT scans to look for injuries. Fortunately there wasn’t anything life-threatening. He was admitted and was later discharged in good condition.

I then got a memo from the hospital several days later stating that Medicare would not pay for the CT scan of the patient’s cervical spine. There is a list of diagnosis codes for which Medicare will reimburse hospitals for performing a CT scan of the cervical spine. That list is contained below. If one of the selected codes is not on the patient’s final diagnosis list, then Medicare tells the hospital “tough luck” and pays the hospital nothing for the scan. As part of Medicare’s Conditions of Participation, the patient may not be charged for the exam unless the patient specifically agrees to the charges. When Medicare doesn’t pay, almost always the hospital gets stuck holding the bag.

If a patient is a victim of multiple trauma and is unconscious, CT scans of the cervical spine are more likely to show significant injury. This study showed that in multiple trauma patients, CT scans picked up on 98.5% of fractures while cervical x-rays only picked up 43% of fractures. It is uncommon to pick up ligamentous injuries on x-rays or CT scans – generally need an MRI for those.
If physicians choose to do a CT scan on an unconscious or poorly responsive patient, according to the “permissible” diagnosis codes, in most cases hospitals have to hope that either an injury or some type of cancer shows up on the CT scan. Otherwise, the CT scan won’t be reimbursed and the hospital eats the cost.

What are the other options in multitrauma patients?
We could just do only x-rays of the cervical spine, and, if negative, tell patients that everything is OK because the government won’t pay for CT scans unless you meet certain criteria. The 57% of patients with cervical spine fractures missed on x-rays will have all their medical needs met under the new health care reform measures anyway.
Or, while bleeding to death and strapped to a backboard wondering if they’re going to live or die, we could give patients an ABN form to sign. “Medicare might not pay for this test, if Medicare doesn’t pay for this test, do you agree to pay the cost of the test yourself — assuming that you live, of course?”
We could always perform x-rays on everyone’s necks first and make up notice some “abnormality on radiological or other exam of the musculoskeletal system” to justify the CT scan. That will be a 793.7 to all you CPT coders.
We could just say that notice that the patient winced in pain when the neck was palpated – causing “cervicalgia.” That’s CPT code 723.1.
Or we can just practice good medicine and let the hospitals get shafted by the system.

Of course, if hospitals get shafted enough by the system, they end up closing or reducing services. Then access to care suffers. You get what you pay for. Do a search for “hospital bankruptcy closures” and see how often it happens. Here are a few examples.

CT scan payments are just one example of the cat and mouse game that constantly goes on between those providing the services and those “paying” for the services.

It is also an example of the “Golden Rule” – he who has the gold makes the rules.

Things aren’t going to get better.

——————————————————————————————————————

Medicare will reimburse the cost of computerized tomography of the cervical spine for the following diagnosis codes:

170.2 MALIGNANT NEOPLASM OF VERTEBRAL COLUMN EXCLUDING SACRUM AND COCCYX
172.4 MALIGNANT MELANOMA OF SKIN OF SCALP AND NECK
185 MALIGNANT NEOPLASM OF PROSTATE
191.0 MALIGNANT NEOPLASM OF CEREBRUM EXCEPT LOBES AND VENTRICLES
191.1 MALIGNANT NEOPLASM OF FRONTAL LOBE
191.2 MALIGNANT NEOPLASM OF TEMPORAL LOBE
191.3 MALIGNANT NEOPLASM OF PARIETAL LOBE
191.4 MALIGNANT NEOPLASM OF OCCIPITAL LOBE
191.5 MALIGNANT NEOPLASM OF VENTRICLES
191.6 MALIGNANT NEOPLASM OF CEREBELLUM NOS
191.7 MALIGNANT NEOPLASM OF BRAIN STEM
191.8 MALIGNANT NEOPLASM OF OTHER PARTS OF BRAIN
191.9 MALIGNANT NEOPLASM OF BRAIN UNSPECIFIED SITE
192.0 MALIGNANT NEOPLASM OF CRANIAL NERVES
192.1 MALIGNANT NEOPLASM OF CEREBRAL MENINGES
192.2 MALIGNANT NEOPLASM OF SPINAL CORD
192.3 MALIGNANT NEOPLASM OF SPINAL MENINGES
192.8 MALIGNANT NEOPLASM OF OTHER SPECIFIED SITES OF NERVOUS SYSTEM
192.9 MALIGNANT NEOPLASM OF NERVOUS SYSTEM PART UNSPECIFIED
193 MALIGNANT NEOPLASM OF THYROID GLAND
194.1 MALIGNANT NEOPLASM OF PARATHYROID GLAND
194.3 MALIGNANT NEOPLASM OF PITUITARY GLAND AND CRANIOPHARYNGEAL DUCT
194.4 MALIGNANT NEOPLASM OF PINEAL GLAND
194.5 MALIGNANT NEOPLASM OF CAROTID BODY
194.6 MALIGNANT NEOPLASM OF AORTIC BODY AND OTHER PARAGANGLIA
195.0 MALIGNANT NEOPLASM OF HEAD FACE AND NECK
196.0 SECONDARY AND UNSPECIFIED MALIGNANT NEOPLASM OF LYMPH NODES OF HEAD FACE AND NECK
198.3 SECONDARY MALIGNANT NEOPLASM OF BRAIN AND SPINAL CORD
198.4 SECONDARY MALIGNANT NEOPLASM OF OTHER PARTS OF NERVOUS SYSTEM
198.5 SECONDARY MALIGNANT NEOPLASM OF BONE AND BONE MARROW
199.0 DISSEMINATED MALIGNANT NEOPLASM
199.2 MALIGNANT NEOPLASM ASSOCIATED WITH TRANSPLANT ORGAN
203.00 MULTIPLE MYELOMA, WITHOUT MENTION OF HAVING ACHIEVED REMISSION
203.01 MULTIPLE MYELOMA IN REMISSION
203.02 MULTIPLE MYELOMA, IN RELAPSE
209.30 MALIGNANT POORLY DIFFERENTIATED NEUROENDOCRINE CARCINOMA, ANY SITE
213.2 BENIGN NEOPLASM OF VERTEBRAL COLUMN EXCLUDING SACRUM AND COCCYX
225.3 BENIGN NEOPLASM OF SPINAL CORD
225.4 BENIGN NEOPLASM OF SPINAL MENINGES
228.1 LYMPHANGIOMA ANY SITE
237.5 NEOPLASM OF UNCERTAIN BEHAVIOR OF BRAIN AND SPINAL CORD
322.0 NONPYOGENIC MENINGITIS
322.1 EOSINOPHILIC MENINGITIS
322.2 CHRONIC MENINGITIS
322.9 MENINGITIS UNSPECIFIED
324.1 INTRASPINAL ABSCESS
336.0 SYRINGOMYELIA AND SYRINGOBULBIA
336.1 VASCULAR MYELOPATHIES
340 MULTIPLE SCLEROSIS
344.00 QUADRIPLEGIA UNSPECIFIED
344.01 QUADRIPLEGIA C1-C4 COMPLETE
344.02 QUADRIPLEGIA C1-C4 INCOMPLETE
344.03 QUADRIPLEGIA C5-C7 COMPLETE
344.04 QUADRIPLEGIA C5-C7 INCOMPLETE
344.09 OTHER QUADRIPLEGIA
344.2 DIPLEGIA OF UPPER LIMBS
344.40 MONOPLEGIA OF UPPER LIMB AFFECTING UNSPECIFIED SIDE
344.41 MONOPLEGIA OF UPPER LIMB AFFECTING DOMINANT SIDE
344.42 MONOPLEGIA OF UPPER LIMB AFFECTING NONDOMINANT SDE
344.5 UNSPECIFIED MONOPLEGIA
349.31 ACCIDENTAL PUNCTURE OR LACERATION OF DURA DURING A PROCEDURE
349.39 OTHER DURAL TEAR
353.2 CERVICAL ROOT LESIONS NOT ELSEWHERE CLASSIFIED
718.78 DEVELOPMENTAL DISLOCATION OF JOINT OTHER SPECIFIED SITE
718.79 DEVELOPMENTAL DISLOCATION OF JOINT MULTIPLE SITES
720.9 UNSPECIFIED INFLAMMATORY SPONDYLOPATHY
721.0 CERVICAL SPONDYLOSIS WITHOUT MYELOPATHY
721.1 CERVICAL SPONDYLOSIS WITH MYELOPATHY
721.90 SPONDYLOSIS OF UNSPECIFIED SITE WITHOUT MYELOPATHY
721.91 SPONDYLOSIS OF UNSPECIFIED SITE WITH MYELOPATHY
722.0 DISPLACEMENT OF CERVICAL INTERVERTEBRAL DISC WITHOUT MYELOPATHY
722.4 DEGENERATION OF CERVICAL INTERVERTEBRAL DISC
722.6 DEGENERATION OF INTERVERTEBRAL DISC SITE UNSPECIFIED
722.71 INTERVERTEBRAL DISC DISORDER WITH MYELOPATHY CERVICAL REGION
722.81 POSTLAMINECTOMY SYNDROME OF CERVICAL REGION
722.91 OTHER AND UNSPECIFIED DISC DISORDER OF CERVICAL REGION
723.0 SPINAL STENOSIS IN CERVICAL REGION
723.1 CERVICALGIA
723.2 CERVICOCRANIAL SYNDROME
723.4 BRACHIAL NEURITIS OR RADICULITIS NOS
730.08 ACUTE OSTEOMYELITIS INVOLVING OTHER SPECIFIED SITES
730.18 CHRONIC OSTEOMYELITIS INVOLVING OTHER SPECIFIED SITES
730.19 CHRONIC OSTEOMYELITIS INVOLVING MULTIPLE SITES
730.28 UNSPECIFIED OSTEOMYELITIS INVOLVING OTHER SPECIFIED SITES
730.38 PERIOSTITIS WITHOUT OSTEOMYELITIS INVOLVING OTHER SPECIFIED SITES
733.00 OSTEOPOROSIS UNSPECIFIED
733.01 SENILE OSTEOPOROSIS
733.02 IDIOPATHIC OSTEOPOROSIS
733.03 DISUSE OSTEOPOROSIS
733.13 PATHOLOGICAL FRACTURE OF VERTEBRAE
733.40 ASEPTIC NECROSIS OF BONE SITE UNSPECIFIED
737.40 UNSPECIFIED CURVATURE OF SPINE ASSOCIATED WITH OTHER CONDITIONS
737.41 KYPHOSIS ASSOCIATED WITH OTHER CONDITIONS
737.42 LORDOSIS ASSOCIATED WITH OTHER CONDITIONS
737.43 SCOLIOSIS ASSOCIATED WITH OTHER CONDITIONS
756.10 CONGENITAL ANOMALY OF SPINE UNSPECIFIED
756.12 SPONDYLOLISTHESIS CONGENITAL
756.13 ABSENCE OF VERTEBRA CONGENITAL
756.14 HEMIVERTEBRA
756.15 FUSION OF SPINE (VERTEBRA) CONGENITAL
756.16 KLIPPEL-FEIL SYNDROME
793.7 NONSPECIFIC ABNORMAL FINDINGS ON RADIOLOGICAL AND OTHER EXAMINATION OF MUSCULOSKELETAL SYSTEM
805.00 CLOSED FRACTURE OF CERVICAL VERTEBRA UNSPECIFIED LEVEL
805.01 CLOSED FRACTURE OF FIRST CERVICAL VERTEBRA
805.02 CLOSED FRACTURE OF SECOND CERVICAL VERTEBRA
805.03 CLOSED FRACTURE OF THIRD CERVICAL VERTEBRA
805.04 CLOSED FRACTURE OF FOURTH CERVICAL VERTEBRA
805.05 CLOSED FRACTURE OF FIFTH CERVICAL VERTEBRA
805.06 CLOSED FRACTURE OF SIXTH CERVICAL VERTEBRA
805.07 CLOSED FRACTURE OF SEVENTH CERVICAL VERTEBRA
805.08 CLOSED FRACTURE OF MULTIPLE CERVICAL VERTEBRAE
805.10 OPEN FRACTURE OF CERVICAL VERTEBRA UNSPECIFIED LEVEL
805.11 OPEN FRACTURE OF FIRST CERVICAL VERTEBRA
805.12 OPEN FRACTURE OF SECOND CERVICAL VERTEBRA
805.13 OPEN FRACTURE OF THIRD CERVICAL VERTEBRA
805.14 OPEN FRACTURE OF FOURTH CERVICAL VERTEBRA
805.15 OPEN FRACTURE OF FIFTH CERVICAL VERTEBRA
805.16 OPEN FRACTURE OF SIXTH CERVICAL VERTEBRA
805.17 OPEN FRACTURE OF SEVENTH CERVICAL VERTEBRA
805.18 OPEN FRACTURE OF MULTIPLE CERVICAL VERTEBRAE
806.00 CLOSED FRACTURE OF C1-C4 LEVEL WITH UNSPECIFIED SPINAL CORD INJURY
806.01 CLOSED FRACTURE OF C1-C4 LEVEL WITH COMPLETE LESION OF CORD
806.02 CLOSED FRACTURE OF C1-C4 LEVEL WITH ANTERIOR CORD SYNDROME
806.03 CLOSED FRACTURE OF C1-C4 LEVEL WITH CENTRAL CORD SYNDROME
806.04 CLOSED FRACTURE OF C1-C4 LEVEL WITH OTHER SPECIFIED SPINAL CORD INJURY
806.05 CLOSED FRACTURE OF C5-C7 LEVEL WITH UNSPECIFIED SPINAL CORD INJURY
806.06 CLOSED FRACTURE OF C5-C7 LEVEL WITH COMPLETE LESION OF CORD
806.07 CLOSED FRACTURE OF C5-C7 LEVEL WITH ANTERIOR CORD SYNDROME
806.08 CLOSED FRACTURE OF C5-C7 LEVEL WITH CENTRAL CORD SYNDROME
806.09 CLOSED FRACTURE OF C5-C7 LEVEL WITH OTHER SPECIFIED SPINAL CORD INJURY
806.10 OPEN FRACTURE OF C1-C4 LEVEL WITH UNSPECIFIED SPINAL CORD INJURY
806.11 OPEN FRACTURE OF C1-C4 LEVEL WITH COMPLETE LESION OF CORD
806.12 OPEN FRACTURE OF C1-C4 LEVEL WITH ANTERIOR CORD SYNDROME
806.13 OPEN FRACTURE OF Cl-C4 LEVEL WITH CENTRAL CORD SYNDROME
806.14 OPEN FRACTURE OF C1-C4 LEVEL WITH OTHER SPECIFIED SPINAL CORD INJURY
806.15 OPEN FRACTURE OF C5-C7 LEVEL WITH UNSPECIFIED SPINAL CORD INJURY
806.16 OPEN FRACTURE OF C5-C7 LEVEL WITH COMPLETE LESION OF CORD
806.17 OPEN FRACTURE OF C5-C7 LEVEL WITH ANTERIOR CORD SYNDROME
806.18 OPEN FRACTURE OF C5-C7 LEVEL WITH CENTRAL CORD SYNDROME
806.19 OPEN FRACTURE OF C5-C7 LEVEL WITH OTHER SPECIFIED SPINAL CORD INJURY
839.00 CLOSED DISLOCATION CERVICAL VERTEBRA UNSPECIFIED
839.01 CLOSED DISLOCATION FIRST CERVICAL VERTEBRA
839.02 CLOSED DISLOCATION SECOND CERVICAL VERTEBRA
839.03 CLOSED DISLOCATION THIRD CERVICAL VERTEBRA
839.04 CLOSED DISLOCATION FOURTH CERVICAL VERTEBRA
839.05 CLOSED DISLOCATION FIFTH CERVICAL VERTEBRA
839.06 CLOSED DISLOCATION SIXTH CERVICAL VERTEBRA
839.07 CLOSED DISLOCATION SEVENTH CERVICAL VERTEBRA
839.08 CLOSED DISLOCATION MULTIPLE CERVICAL VERTEBRAE
839.10 OPEN DISLOCATION CERVICAL VERTEBRA UNSPECIFIED
839.11 OPEN DISLOCATION FIRST CERVICAL VERTEBRA
839.12 OPEN DISLOCATION SECOND CERVICAL VERTEBRA
839.13 OPEN DISLOCATION THIRD CERVICAL VERTEBRA
839.14 OPEN DISLOCATION FOURTH CERVICAL VERTEBRA
839.15 OPEN DISLOCATION FIFTH CERVICAL VERTEBRA
839.16 OPEN DISLOCATION SIXTH CERVICAL VERTEBRA
839.17 OPEN DISLOCATION SEVENTH CERVICAL VERTEBRA
839.18 OPEN DISLOCATION MULTIPLE CERVICAL VERTEBRAE
847.0 NECK SPRAIN
952.00 C1-C4 LEVEL SPINAL CORD INJURY UNSPECIFIED
952.01 C1-C4 LEVEL WITH COMPLETE LESION OF SPINAL CORD
952.02 C1-C4 LEVEL WITH ANTERIOR CORD SYNDROME
952.03 C1-C4 LEVEL WITH CENTRAL CORD SYNDROME
952.04 C1-C4 LEVEL WITH OTHER SPECIFIED SPINAL CORD INJURY
952.05 C5-C7 LEVEL SPINAL CORD INJURY UNSPECIFIED
952.06 C5-C7 LEVEL WITH COMPLETE LESION OF SPINAL CORD
952.07 C5-C7 LEVEL WITH ANTERIOR CORD SYNDROME
952.08 C5-C7 LEVEL WITH CENTRAL CORD SYNDROME
952.09 C5-C7 LEVEL WITH OTHER SPECIFIED SPINAL CORD INJURY
952.8 MULTIPLE SITES OF SPINAL CORD INJURY WITHOUT SPINAL BONE INJURY
953.0 INJURY TO CERVICAL NERVE ROOT
996.40 UNSPECIFIED MECHANICAL COMPLICATION OF INTERNAL ORTHOPEDIC DEVICE, IMPLANT, AND GRAFT
996.49 OTHER MECHANICAL COMPLICATION OF OTHER INTERNAL ORTHOPEDIC DEVICE, IMPLANT, AND GRAFT
V10.01 PERSONAL HISTORY OF MALIGNANT NEOPLASM OF TONGUE
V10.02 PERSONAL HISTORY OF MALIGNANT NEOPLASM OF OTHER AND UNSPECIFIED PARTS OF ORAL CAVITY AND PHARYNX
V10.21 PERSONAL HISTORY OF MALIGNANT NEOPLASM OF LARYNX
V10.22 PERSONAL HISTORY OF MALIGNANT NEOPLASM OF NASAL CAVITIES MIDDLE EAR AND ACCESSORY SINUSES
V10.81 PERSONAL HISTORY OF MALIGNANT NEOPLASM OF BONE
V10.86 PERSONAL HISTORY OF MALIGNANT NEOPLASM OF OTHER PARTS OF NERVOUS SYSTEM
V67.00 FOLLOW-UP EXAMINATION FOLLOWING UNSPECIFIED SURGERY
V67.09 FOLLOW-UP EXAMINATION FOLLOWING OTHER SURGERY
V67.1 FOLLOW-UP EXAMINATION FOLLOWING RADIOTHERAPY
V67.2 FOLLOW-UP EXAMINATION FOLLOWING CHEMOTHERAPY
V71.1 OBSERVATION FOR SUSPECTED MALIGNANT NEOPLASM

24 Responses to “How Payments Affect Care”

  1. zoe says:

    I am a doc, not a coding expert, but in the hospital the “rule out” codes can sometimes be used, unlike outpatients. I think that means that your “rule out neck sprain” would cover this guy. I agree this is just more ways to make it difficult to get honest money for honest services, but I do think your hospital coders can help educate docs on how to play the game.

  2. medrecgal says:

    Hey, not to be a nitpicker or anything, but it’s sort of in my job description…all those codes you’re talking about are not CPT codes but ICD-9-CM codes. And as far as I’m concerned, Medicare is nothing but a big old pain in the ass. (I’m sure there’s a code for that, too, possibly more than one!) The injury codes are by far the worst to deal with. They are just so damn specific sometimes, and yet there are also many cases where you have to resort to some junky code like 793.7 which tells you almost nothing.

    I also know there are many docs out there who think we are collectively also nothing but a pain in the ass, but the need for coders is obviously a byproduct of a system that’s truly completely f-ed up. As you said, the kind of care docs can provide should not be so tied into reimbursement. That’s just a neon sign for the need for health care reform.

  3. paul says:

    just call the medical director of medicare or whatever insurance company in real-time and ask them to approve the study. if they don’t, and an injury is missed, they can be responsible for it.

  4. Inthebiz says:

    You can’t ask for ABN’s in the ER…

    • WhiteCoat says:

      Hyperbole. Of course we’re not going to ask a patient with a possible broken neck whether or not they want to forgo a scan.
      ABNs cannot be used before an emergency medical condition has been stabilized. In a non-emergency and absent “great duress,” ABNs are appropriate – at least according to CMS.

      • Inthebiz says:

        But by the time you’ve determined whether an emergency condition exists, the scan has been done. If you already know it’s not an emergency, no need for a scan…

  5. shadowfax says:

    Twit. 847.0 — neck sprain, and 723.1 – Neck Pain are the standard indicators for CT neck in trauma. Always have been. Yes, it’s silly that medicare requires a “diagnosis” and not a “rule-out” indication, and it’s true that the comatose trauma patient can’t tell you they have “neck pain” so it makes no sense to code it that way. But the rules have been that way for a decade or more, and your hospital’s order entry system should have been built to incorporate those rules (or your unit clerks & rad techs should have been educated to enter the orders compliantly).

    More to the point, if the patient was, as you say, admitted, then the hospital got paid nothing for any of the CT scans or other ancillary studies, because the hospital got paid based on DRG codes and not APC codes. (APC codes reimburse radiology studies as a line-item procedure, DRG codes pay a global fee based on diagnoses.)

    Provocative rant, for sure, but factually off base.

    • WhiteCoat says:

      I’m not a coding guru, so all I can say is that when people who do coding for a living come up to me and tell me these things, I tend to trust that they know what they’re talking about.

      And when CMS steps up its enforcement of “fraud” and comes looking for fines and treble damages because you’re billing for a neck sprain when you haven’t (and can’t) document one and are billing for neck pain when patients can’t complain of neck pain, I bet they’ll just go away when your billing department tells them “Gee, we’ve done things that way for a decade or more. Besides, Dr. Shadowfax made reference to some vague ‘coding rules’ that say it’s OK.”

      • Max Kennerly says:

        It’d take a lot more than CT Scans on a trauma victim to get hit with a False Claims Act case. The US Attorneys usually don’t bother with FCA unless the damages are in the millions, and even then only if they believe they can prove intent to defraud.

        An audit is a different story. Stakes are a lot lower, though.

  6. Ted says:

    Seems like an easy (and appropriate) answer to this problem is to add “Altered level of consciousness after trauma” to the indications list.

    I think that would require making a new ICD9 code.

    • WhiteCoat says:

      That would make perfect sense, but the government is looking to decrease expenditures, not increase them, so I doubt that it would happen.

  7. Nurse K says:

    I can’t believe Shadowfax just called WhiteCoat a twit.

    Very Happyesque post btw. I puked a little in my mouth.

  8. M. Student says:

    So given that pretty comprehensive list of indications for a cervical CT, what percent of CT scans performed actually end up falling into an unreimbursed gray zone? This seems like a pretty small loophole to close from my perspective.

    • Ted says:

      I’d estimate at least 1/4 (and probably more like 1/2) of the c-spine CTs done where I work (level I trauma center) are for altered LOC post polytrauma.

  9. Glen in Texas says:

    While your EMR may have problems with it, Medicare is required to accept up to 8 diagnosis codes.

    It is wise to use more than the traditional four, for the reasons you give.

  10. Doctor D says:

    Another trauma Catch-22:

    Most insurance won’t cover any treatment for trauma sustained while intoxicated. So hospitals get stuck with millions in costs of caring for drunk or drugged drivers.

    So a hospital at which I once worked just decided to ban all blood alcohol levels and drug screens on trauma patients. It can’t be denied for intoxication if we don’t check for them. We were stuck blindly guessing if trauma patient was gorked because of his injury or the Gray Goose he had before the crash.

    Ah, the brilliance of insurance bureaucrats and hospital administrators!

  11. NormD says:

    What did the CT scans cost? My wife had appendicitis and her CT scan was billed at $11000. She was out of the room for 30 minutes so it could not have taken very long. No patient is going to pay this, its stupid and completely unrelated to the scan’s cost. Tell me the CT is a few hundred dollars and it would seem reasonable to bill the patient.

  12. Keep a pipe cleaner around. Place the pipe cleaner advantageously under the patients neck. X-Ray the cervical spine. Notice the strange shadow in the patient’s neck. Diagnose “Undetermined angulated adhesion with apparent calcification”. Then, do the CT scan.

    I’m not a doctor, so I may have gotten some of the details wrong.

  13. throckmorton says:

    I think we need a whole new group of ICD-9 codes. We could call them the V911 codes.

    V911.1 (Frogger) Got drunk tried to run accross interstate
    V911.2 GDFD (Got drunk Fell down)
    V911.33 MMOB GS (Minding own business, got shot)

    and so on.

  14. medrecgal says:

    OMG…throckmorton, those V911 codes are absolutely hilarious! Too bad the bureaucrats are way too serious to even consider something that might actually be useful while still imparting a touch of warped humor…

  15. Bleeding heart says:

    At least in Canada we don’t have to deal with that bullshit.

  16. [...] Doctor/hospital continues to provide existing level of treatment and simply eat the extra cost.  Some say this already happens. [...]

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