How Would You Code It?

Several years ago, two young men were at work inspecting the installation of a new septic system for a house being built in a brand new subdivision in a rapidly developing area on the ever-expanding outskirts of the city of Atlanta. They arrived at the home, which was little more than a concrete foundation and a timber frame with no windows or doors, and headed around back where the septic system had been installed. In addition to keeping each other company, working as a team allowed them to work more efficiently: One could draw up the layout of the system and fill out the paperwork, while the other could actually inspect the system to ensure that it met state regulatory guidelines.

At this particular inspection, the installer was one of the men’s least favorite people. He was ill-tempered, a real hot-head with a mean streak and the profanities to express it. In fact, both men were surprised to see him, because the last they knew, he had actually been sentenced to an indeterminate amount of time in the county jail for one or more of a variety things he had managed to get caught doing. Had he been caught doing everything he had been doing, jail would have likely given way to prison. The installer greeted one of the young men with a nickname–“Hey Brunswick!”–that merely described where the young man was from, despite being wielded pejoratively. Ignoring the remarks, the inspection began.

Now, while both men usually wore boots, one of the young men–for reasons unknown–decided to wear a far less substantial pair of shoes with soles made out of cork. That was his first mistake. His second mistake was not looking down while he walked around the home site, sketching the layout of the system and filling out the paperwork. Both mistakes were brought to his attention when he felt a sudden sharp pain in the bottom of his right foot. Looking down, he saw that he was standing on a board, and it didn’t take him long to realize that he had just stepped on a nail securely anchored upright by a two-by-four. He wanted to cry out, but didn’t, because he didn’t want to hear any comments about how “Brunswick must not know not to step on nails!” So, with one foot providing resistance to the board, the young man raised his other foot off the nail, and hobbled back to the truck that carried both men from one site to the next.

When his partner returned, the young man explained that he had stepped on a nail and needed some medical attention. They went to the doctor, who took a look at the half-inch puncture wound, debrided it, applied an antibiotic and a bandage, and gave the young man a tetanus shot. The entire visit took 15 minutes. Then the doctor sat down to fill out his own paperwork and had to decide how to code the incident. There would be a separate charge for the tetanus shot, certainly, but then it was less clear. Was this a simple visit, an intermediate visit, or a complex visit? How is the doctor to decide that? Is it based on how long the visit took? What problem the patient presented with? How much the doctor feels like being reimbursed? (Complex visits pay better than simple ones, you know.) So, let me ask you, if you were the doctor, how would you code it? Simple, intermediate, or complex? Why? Would your answer change if you weren’t paid differently for each type?

Note: I was the young man in this story, and let me just go on the record that stepping on a nail is incredibly painful. I actually was seen at the health department for free, and given the same advice I now give you: Always wear boots around construction sites, and keep your tetanus booster up-to-date.

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