Wednesday, June 3, 2009


Every profession has it's own vocabulary. The vocabulary of medicine is notorious for it's complexity. "Inspection of the malar area revealed a patch of vitaligo next to a maculopapular rash that the patient states is puritic." Translation: "This patient has an area on her cheek that has both lost it's pigment and a rash that is visiable, palpable and itches." Dysuria means it hurts when you pee, excuse me urinate. A cholecystectomy is the removal of a patients gall bladder as opposed to a cystotomy which is making an incision in a cyst, even that big cyst that all of us have, the urinary bladder.

Today puzzling over what it is that physicians do, I realized that I went to school for four years to learn all these words. Then I spent another four years learning how to use them with other physicians while also learning to translate them back into a language patients can understand. Now that I am in practice, to get paid I have to use an entirely new language: Current Procedural Terminology or CPT for short.

CPT codes are numbers that insurance companies use to determine payment. The reimbursement I receive for a patient visit is based on the number of questions I ask, the number of body parts I examine and the time I spend explaining the diagnosis and treatment to the patient. All of this must be properly matched with a numerical code that is put into the computer and sent to the insurance company in order to receive payment. No one is ever told in medical school that the system is run this way. Why would anyone spend all that time learning a complicated language only to then learn some sort of Morse Code system so that the insurance company will pay you?

As I write this, I realize that in the practice of medicine I now use three languages. There is the language I speak to the patients. It is much the same that I use with friends and family. This language is English, hopefully as plain and simple as I can make it so that the patient I am caring for will understand what I believe is happening to them and what my plans are for treating this condition.

My second language is the one I use with other physicians and the health care team. I love this language. I have spent years learning it. I enjoy reading medical journals, talking with colleagues and attending conferences where it is used. The preciseness of this language is helpful in the diagnosis and treatment of patients.

This third language I consider a necessary evil. Without it I will not get paid. I am not proud of the fact that I know a 99213 is a specific level of office service or that V25.1 is the code for contraception counseling. These are facts that seem to clutter my brain. They do not make me a better physician or even a nicer person. Knowing this language only allows me to succeed at billing for my services.
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