More Misadventures (As My Blog Title Would Imply)

September 13, 2010
David Lubin, MD

Dr. Lubin provides more examples that show why the title of his blog, "Code E876.9: Unspecified Misadventures During Medical Care" is so appropriate.

I’m really glad I titled my blog "Code E876.9 - Unspecified Misadventures during Medical Care;" sometimes, when my practice gets crazy, it couldn’t seem more appropriate. Here are a couple of stories about patients that confirm my decision.

I saw a lady in her late 30s and her calcium was high. Further workup, with an elevated parathyroid hormone, pointed to parathyroid disease. For those not in the medical field, the parathyroids sit slightly behind the thyroid glands in the neck and control calcium levels in the blood and bones. I ordered a CT scan of the neck, but the insurance company denied it, stating that I hadn’t ordered an ultrasound and/or a nuclear study yet. We had sent the insurer my office notes and the lab work, indicating why the workup was needed.

So, to make the insurance company happy, I ordered those tests, which were again denied. I received a letter stating they wanted the “current signs and symptoms indicating the exam” (there weren’t any, just the abnormal labs), “prior diagnostic studies with results” (again, there weren’t any, since they didn’t let me order the CT scan), “prior management” (I won’t even address that), and “medications with dose and duration”(you could probably hear me screaming throughout the building).

I got on the phone and after speaking with two or three subordinates, finally reached a medical advisor. She told me she didn’t have the labs. Well, we had faxed them with my notes, knowing the insurer would have to see that information. All I had to do was tell her the labs and she gave me an authorization number. The steam flow was slowly subsiding from my ears.

Then a 76-year-old lady, who had her left carotid artery cleaned out three years ago, was asking if she needed to continue her Plavix, a drug used to thin her blood and keep plaques from breaking loose. She had no bruits in her neck and I suggested a carotid ultrasound to see how it compared to her tests pre-surgery when the blockage was found. It’s a simple, noninvasive, relatively inexpensive test. Well, apparently not for those who run the show in the Medicare approval department.

The clerk from the radiology office called and asked for a diagnosis to go along with the test. You have to have an appropriate diagnosis to go along with the order for the test in order to get paid. My completely rational, accurate diagnosis of “peripheral vascular disease” didn’t work. Hmmm, well, she was old and had some memory loss, let’s try that. “Memory Loss” for $200. No go. Well then, Alex, “Dizziness” for $400. Still no winner. Ok, screw it; just use CVA, or cerebrovascular accident, a long phrase for a stroke (which I was in danger of having while trying to come up with a diagnosis). Finally… that worked.

One more, funnier, misadventure from the other day: I Had to call CVS/Caremark to initiate a prior authorization for a prescription. They screwed up and faxed the wrong number. We called the number a few times. It was a gay sex phone line. They corrected it later. The prescription was for Cialis. I swear. And they gave it to him.