Undercoding Is Common

Physician's Money Digest, March15 2005, Volume 12, Issue 5

A study of coding practices by family practitionersshows that the average physician's bill reflectsonly 1.97 conditions per patient visit, when the actualnumber of problems the doctor addresses perpatient visit averages 3.5. The study by the Universityof Wisconsin Medical School concludes that doctorsoften don't code for counseling about emotionalproblems, mental illness, alcoholism, or substanceabuse when submitting bills to insurance companies.

The reasons:

Even though doctors can spend as much as 30% oftheir time dealing with these health issues, they areaverse to coding for them. They knowthird-party payers generally won't consider theseclaims, and they're concerned that patients will loseinsurance coverage if the company knows they havean addiction or other emotional problem.

The study points out, however, that in additionto losing income, doctors who undercode skew thedata on which many quality measurement programsare based, which could have a greater impact as moreof these programs are launched.