These Coders Have Got to Go

Just the other day, I received an envelope in my hospital mailbox, addressed to me, from our group’s billing manager. I stared at the sender’s name for a second, not recognizing who it was, and wondered, what could they possibly want from me? Without further delay, I opened up the envelope to find a letter attached to 10 reports of mine. The letter stated that I needed to issue addendums on all of these 10 reports, because they were being rejected for various reasons.

What? Rejected for what reasons? The doctor already has the report, and has (hopefully) read the report, and acted on it. To be honest, that’s really the most important issue to me. What could be wrong after that part is complete? So as not to irritate the billing company, and to increase the odds of getting paid the whopping $40 for the obstruction series that I dictated two months ago, I analyzed each reason as to why they were being sent back to me for addendums for each of the reports. Three of them were because I stated in the header of my report, “Obstruction series.” According to the powers that be, that’s no longer acceptable in 2016. Instead you must dictate, “erect PA chest and/or supine or decubitus views of the abdomen.”

Are you kidding me? The referring doctor certainly knows what he/she is ordering when he/she orders an obstruction series, and he/she certainly has some idea of what the report is going to comment on when he/she goes to read it. Why do I have to explain in a full, waste of time sentence the individual radiographs that constitute an obstruction series?

I continued with my analysis and went on to the next case. It was a noncontrast CT of the abdomen and pelvis done for renal stone search. I like to call these studies, “GU stone protocol,” and that’s actually my Powerscribe moniker that I dictate. Well, that may fly for Powerscribe voice recognition, but the report was being sent back to me because, a) I failed to mention that the CT dose was recorded and was being stored in PACS, and b) I failed to mention that CT dose reduction techniques were utilized AND I needed to mention in particular which ones.[[{"type":"media","view_mode":"media_crop","fid":"48433","attributes":{"alt":"radiology rejection","class":"media-image media-image-right","id":"media_crop_7119023606683","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"5774","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"height: 157px; width: 170px; border-width: 0px; border-style: solid; margin: 1px; float: right;","title":"©aarisham/Shutterstock.com","typeof":"foaf:Image"}}]]

Are you kidding me? What happened to the days of reading 10, 20 CTs of the head, neck, chest, body, and MSK exams just a few years back when our reports were short, succinct, and had none of these waste of time added caveats that are included simply to satisfy CMS, JACHO, and the coders for ICD-10 and beyond? We never mentioned CT dose reduction techniques. If the patient was 450 lb, the tech knew to just max out the mAs, increase the table speed, or slice thickness, or do whatever it took to obtain the best image with the least noise.

At this point in time, my blood pressure began to rise, and I was getting hot under the collar. I figured I would read one more; just maybe there would be a reasonable legitimate reason why my reports were being rejected. The case was an ankle radiograph of someone with pain after a trip and fall injury. There on my report was a little yellow Post-it note from the biller. Apparently, I failed to mention in the header of my report that the patient had been having pain for two weeks. I had simply stated, “ankle pain, s/p fall.” According to the powers that be, that doesn’t fly. You must indicate the length of time the patient has been experiencing symptoms. Are you kidding me?

I couldn’t take any more, nor could I bear to read any more. I stuffed the letter back in the envelope, put it back in my mailbox and stomped back to my workstation, longing for the good old days of radiology when things were much simpler.