Irritant Codes For Doctors

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In my sometimes-quixotic quest to improve the medical profession, I have created a series of modifiers to radically transform diagnosis and procedure coding. In my struggle for simplicity, I suggest a modest 2% increase in physician reimbursement for each that applies. If, however, more than five "irritant codes" apply to any individual procedure or patient, the value of the combined modifiers should double.
Telephone travails 455.76 Patient who calls (usually exclusively) on weekends, religious holidays or known doctor's day off with a 3-week-old problem and who didn't call during office hours, "not wanting to bother the doctor while he/she was busy with patients." 455.76z applies to the same call made after 11 p.m. 455.76zq is used when the problem is more than 3 years old. Consultation consternation D764.5 Emergency consultation Friday afternoon within five minutes of office closing time for a patient who has been hospitalized for two weeks but suddenly requires a consultant's opinion before discharge is possible. D764.56 applies when the requesting physician does not make the request personally. D764.56! is used when the requesting doctor consistently sends his/her patients to a rival consultant of yours who coincidentally happens to be inconveniently on vacation at the time of this request. Scheduling snits 894.4 Patient demanding an emergency office visit who insists on an appointment time that will not interfere with a favorite television show, manicure, golf game or child's soccer practice. 894.445 applies when that patient has been added to an already vastly overcrowded schedule (and informed of that fact), who then asks (894.455a with an attitude) if the wait to see you will be more than five minutes. 894.455w is used when that same patient requests either a discounted fee or a co-pay waiver because of an upcoming vacation. The modifier is doubled if the vacation is in the South Pacific or involves first-class air, and triples if travel is by Concorde. The modifier increases tenfold if the destination involves a casino and the patient is a two-pack-a-day smoker who drinks only single-malt Scotch. Oh-hold hell 888.45D Applies to each 30 seconds of phone waiting time you spend attempting to obtain approval from an insurance company for a patient's medication. Modifier is doubled if the insurance company phone menu is more than five layers deep. 888.45MD applies to each 15 seconds of time you are on hold when another doctor wants to speak with you and, instead of placing the call personally, has his/her secretary call and make you hold to wait for the calling physician to come on the line. Modifier doubles if on-hold music is "The Best of Cher." Noncompliance nastiness 458.87 Angry patient who claims to be "not one single bit better," demands return of his/her prior co-pay and then takes 10 minutes before casually admitting failure to either fill or use the prescription given at the previous office visit. 458.87F Triple-value modifier used when the patient employs three or more obscenities in his/her tirade against you.			Electronic exasperations 411.00 Patient who continues cell phone conversation after you enter exam room. 411.02 refers to similar situation involving a teenager with a portable stereo or electronic game. Child care chaos 299.002 Patient who gives child/children peanut butter, crackers or other potentially messy snacks while in exam room. Modifier doubles when patient asks office nurse to clean up the mess. 299.002p applies when all printed patient information material has been given to child/children for use as coloring paper. 299.002s is used when patient allows child/children to forage through drawers and drool on supplies. Modifier doubles if parent says, "Johnny wants to be a doctor, so I let him open the drawers." 299.002yuk Applies to a soiled diaper left hidden behind the exam table. No-show nettlesomeness 493.99 Patient with more no-shows than kept appointments who sternly chides doctor about running 10 minutes late. Modifier negated if physician allows more than three failed appointments in any one year without comment to patient. 433.99b refers to a patient with very overdue account balance because of either a failure to return insurance company forms regarding student status of dependent or a pre-existing condition. When asked for payment, the patient refuses and insists the office manager call the carrier and "fix" things. Polydrug pique 887.57 Polydrug patient who does not know the names of any of his/her medications. Modifier doubles when patient claims life-threatening allergies to three major antibiotics but is not sure which ones. Piggybacking peeves 887.57rel Patient's relative or friend who is not your patient and who has no appointment but is accompanying your patient and asks questions about his/her own medical problems. Modifier doubles if person becomes nasty when asked to register as a patient, even if you agree to immediate treatment, because he/she does not want to pay a co-pay. Triples each time he/she says, "but this will only take a few minutes." "A while" annoyance Finally, I offer a code that every physician can use with almost every patient: j588.33 Patient who, when asked how long his/her medical problem has existed, answers "a while."
I know my list is far from comprehensive. Have any to add? I have included my e-mail address. (offped@aol.com) Dr. Greenberg is a dermatologist in Elk Grove Village, Ill. and author of the novel A Man of Sorrows (http://www.anovelvision.com/).