How everything became surgery - WaPo [View all]

[question everything]

When George Lai of Portland, Oregon, took his toddler son to a pediatrician last summer for a checkup, the doctor noticed a little splinter in the child’s palm. “He must have gotten it between the front door and the car,” Lai later recalled, and the child wasn’t complaining. The doctor grabbed a pair of forceps — a.k.a. tweezers — and pulled out the splinter in “a second,” Lai said. That brief tug was transformed into a surgical billing code: Current Procedural Terminology (CPT) code 10120, “incision and removal of a foreign body, subcutaneous” — $414.

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When Helene Schilders of Seattle went to her dermatologist for her annual skin check this year, she mentioned a skin tag that her clothing was irritating. The doctor froze the tag with liquid nitrogen. “It was squirt, squirt. That’s it,” Schilders told me. She was “floored” by an explanation of benefits that said the simple treatment had been billed as $469 for surgery. Assuming the bill was a mistake, she called the doctor’s office and was told that surgery had indeed occurred — because the skin was broken in the process. Hence surgical CPT code 17100, “destruction of 1-14 benign lesions.”

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But more and more minor interventions have been rebranded and billed as surgery, for profit. These tiny interventions don’t yield huge bills — in the hundreds rather than the thousands of dollars — but cumulatively, they likely add up to tens if not hundreds of millions of dollars for doctors and hospitals annually. The surprise bills often catch patients off-guard. And they must pay up if they haven’t met their insurance deductible. Even if they have, “surgery” generally requires a coinsurance payment, while an office visit doesn’t.

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The blizzard of surgeries-in-name-only is a symptom of a system that has long valued procedures far more than intellectual work in its payments to medical providers. That merits rethinking, and there are some hints that the incoming presidential administration might be interested in doing so.

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We are in an era when a neurologist spending 40 minutes with a patient to tease out a diagnosis is paid less for that time than a dermatologist spending a few seconds squirting a dollop of liquid nitrogen onto the skin.

https://wapo.st/3OS4xTU

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