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Popular Quotes By Famous People (Had They Been a Doctor or a Nurse).

Ever wonder what Bill Clinton or Martin Luther King or Jesus would have said if they were a doctor or a nurse? Ever wonder what their famous quotes would have sounded like had they been in the medical field? The Happy Hospitalist has. Doctors and nurses are different. Their training changes them. In some ways for the good and and some ways for the bad. For many , they develop a different sense of humor. That's good for you because that's how we found out what Bill Clinton actually would have said if he tried albuterol instead of marijuana. We discover what Martin Luther King's 'I Have a Dream' speech would have been titled if he was a Dermatologist instead. And we discover what Jesus, as head spokesman for the Palliative Care Association of America, really meant for DNR to mean.

No longer do you have to wonder how life would have been if these famous people were in the medical field. Years of investigative journalism has uncovered the answers to this questions.

Soup Nazi, MD - "No Dilaudid for you!"

The real quote - "No soup for you!"

No Dilaudid for you photo famous people humor meme.

Bill Clinton, MD - "I experimented with albuterol a time or two, and I didn't like it. I didn't inhale and I never tried it again."

The real quote - "I experimented with marijuana a time or two, and I didn't like it. I didn't inhale and I never tried it again."

I experimented with albuterol a time or two, and I didn't like it. I didn't inhale and I never tried it again. Bill Clinton ecard humor photo.

Julius Caesar, RN - He actually said, "I came. I saw. I gave Ativan."

The real quote - "I came. I saw. I conquered."

Julius Caesar, RN. I came. I saw. I gave Ativan nurse ecard humor photo.

Jesus, MD - "Choose DNR when you're Dead 'N Ready."

Things Jesus would say if he was a doctor. Choose DNR when you're Dead 'N Ready nurse ecard humor photo.

Martin Luther King Jr, MD - "I Have a Cream"

He really said - "I Have A Dream."

If Martin Luther King Jr was a Dermatoligist I Have a Cream speech ecard humor photo.

George H.W. Bush, RN - "Read my lips: no new preauthorization faxes".

He really said - "Read my lips: no new taxes."

George H.W. Bush, RN. Read my lips: no new preauthorization faxes nurse ecard humor photo.

Abraham Lincoln, RN - "Ativan works better than words."

He really said - "Actions speak louder than words."

Abraham Lincoln, RN. Ativan works better than words nurse ecard humor.

Theodore Roosevelt, RN - "Speak softly and carry a big vial of Ativan."

He really said - "Speak softly and carry a big stick."

Theodore Roosevelt, RN. Speak softly and carry a big vial of Ativan nurse ecard humor photo.

Jane Fonda, RN - "No pain, no Dilaudid."

She really said - "No pain, no gain."

Jane Fonda, RN. No pain, no Dilaudid nurse ecard humor photo.

Buddha, RN - "Peace comes from within Haldol. Do not seek it without it."

He really said - "Peace comes from within. Do not seek it without it."

Buddha, RN. Peace comes from within Haldol. Do not seek it without it nurse ecard humor photo.

Socrates, RN - "The only true wisdom is in knowing you know how to dose Haldol."

He really said - "The only true wisdom is in knowing you know nothing."

Socrates, RN. The only true wisdom is in knowing you know how to dose Haldol nurse ecard humor photo.

Sir Isaac Newton, RN - "To every action there is always opposed an equal reaction to give Ativan."

He really said - "To every action there is always opposed an equal reaction."

Sir Isaac Newton, RN. To every action there is always opposed an equal reaction to give Ativan nurse ecard humor photo.

Winston Churchill, RN - "Never, never, never give up on an IV start."

He really said - "Never, never, never give up."

Winston Churchill, RN. Never, never, never give up on an IV start nurse ecard humor photo.

John F. Kennedy, RN - "My fellow Americans, ask not what your nurse can do for you, ask what you can do for your nurse."

He really said - "My fellow Americans, ask not what your country can do for you, ask what you can do for your country."

John F. Kennedy, RN. My fellow Americans, ask not what your nurse can do for you, ask what you can do for your nurse ecard humor photo.

Jim Valvano, RN - "Don't give up. Don't ever give up on your IV start."

He really said - "Don't give up. Don't ever give up."

Jim Valvano, RN. Don't give up. Don't ever give up on your IV start nurse ecard humor photo.

United Negro Nursing College Fund Slogan - "A vial of Ativan is a terrible thing to waste."

The real slogan - "A mind is a terrible thing to waste."

United Negro Nursing College Fund Slogan. A vial of Ativan is a terrible thing to waste nurse ecard humor photo.

Rodney Dangerfield, RN - "Why don't you call me sometime when you have no caths."

In the movie Back To School, he really said - "Why don't you call me sometime when you have no class."

Rodney Dangerfield, RN. Why don't you call me sometime when you have no caths ecard medical meme humor photo.

This post contains humor that may only be understood by some health care professionals. Read at your own risk.

99224 CPT® Code Description, Progress Notes, RVU, Distribution.

This 99224 CPT® lecture reviews the procedure code definition, progress note examples, distribution and RVU values for this relatively new subsequent observation care evaluation and management (E/M) code. CPT stands for Current Procedural Terminology. CPT® 99224 is the lowest (level 1) subsequent observation care code in this family of codes (99224, 99225 and 99226) and is part of the Healthcare Common Procedure Coding System (HCPCS). Observation care is considered outpatient care. A patient is considered outpatient until inpatient admission to a healthcare facility occurs. This procedure code lecture for subsequent observation care is part of a complete series of CPT® lectures written by myself, a board certified internal medicine physician with over ten years of clinical hospitalist experience in a large community hospitalist program. I have written my collection of evaluation and management (E/M) lectures over the years to help physicians and non-physician practitioners (nurse practitioners, clinical nurse specialists, certified nurse midwives and physician assistants) understand the complex criteria needed to stay compliant with the Centers for Medicare & Medicaid Services (CMS) and other third party insurance companies.

You can find my entire collection of constantly updated medical billing and coding CPT® lectures together in one place on my Pinterest site (CPT® lectures here and other associated E/M lectures here). You don't need to be a Pinterest member to get access to any of my CPT® procedure lectures. As you gain understanding of these E/M procedure codes, remember you have an obligation to make sure your documentation supports the level of service you are submitting for payment. The volume of your documentation should not be used to determine your level of service. The details of your documentation are what matter most. In addition, the E/M services guide says the care you provide must be "reasonable and necessary" and all entries should be dated and contain a CMS defined legible signature or signature attestation, if necessary.

99224 MEDICAL CODE DESCRIPTION

The Centers for Medicare & Medicaid Services (CMS) has recognized subsequent observation care codes (99224-99226) since calendar year 2011's Physician Fee Schedule (PFS) with comment period (CMS-1503-FC). CPT® codes 99224-99226 should be used by the admitting physician for day(s) other than the initial or discharge date. Consulting physicians should continue to use established outpatient care codes 99211-99215 instead for all days other than the initial encounter, in most circumstances.

My interpretations discussed below are based on my review of the 1995 and 1997 E&M guidelines, the CMS E&M guide and the Marshfield Clinic audit point system for medical decision making. These resources can be found in my hospitalist resources section. The Marshfield Clinic point system is voluntary for Medicare carriers but has become the standard audit compliance tool in many parts of the country. You should check with your own Medicare carrier in your state to verify whether or not they use a different criteria standard than that for which I have presented here in my free educational discussion. I recommend all readers obtain their own updated CPT® reference book as the definitive authority on CPT® coding. I have provided access through Amazon to the 2015 CPT® standard edition pictured below and to the right. The American Medical Association (AMA) describes the 99224 CPT® procedure code as follows:

Subsequent observation care, per day, for the evaluation and management of a patient, which requires at least two of these three key components: problem-focused interval history; problem-focused examination; medical decision making that is straightforward or of low complexity. Counseling and/or coordination of care with other clinicians or agencies is provided consistent with the nature of the problem(s) and the patient’s and/or family’s needs. Usually, the patient is stable, recovering, or improving. Physicians typically spend 15 minutes at the bedside and on the patient’s hospital floor or unit.

This medical billing code can be used for time based billing when certain requirements are met. However, documentation of time is not required to remain compliant with CMS regulations. If billed without time as a consideration, CPT® 99224 documentation should comply with the rules established by the 1995 or 1997 guidelines referenced above. The three important coding components for a subsequent observation care evaluation are:

History
Physical Exam
Medical Decision Making Complexity (MDM)

Of note, the E/M coding requirements for CPT® 99224 are exactly the same as subsequent hospital care CPT® 99231. For all subsequent observation care codes (99224-99226), the highest documented two out of three above components determines the correct level of service code. This is different from initial observation care encounter (99218-99220) rules, which require the highest documented three out of three above components.

In addition to a face-to-face encounter, what are the absolute minimum requirements for this level one 99224 visit?

Problem focused interval history: Requires only 1-3 components for the history of present illness (HPI) or documentation of the status of three chronic medical conditions. No past medical history or social history or family history or review of systems is required. Note, just one component of the HPI is required.
Problem focused physical exam: Requires requires 1-5 organ systems (1997 guidelines). Three vital signs are considered one organ system. Therefore, documentation of just three vital signs meet criteria for a low level hospital follow up billing code. The CMS E&M guide on pages 31 and 32 describes the acceptable body areas and organ systems on physical exam.
Straight forward or low complexity medical decision making (MDM): This is split into three components. The 2 out of the 3 highest levels in MDM are used to determine the overall level of MDM. The level is determined by a complex system of points and risk. What are the three components of MDM and the minimum required level of points and risk as defined by the Marshfield Clinic audit tool?

Diagnosis (1 point)
Data (0 points)
Risk (minimal)

The medical decision making point system is highly complex. I have referenced it in detail on my E/M pocket cards described below. These cards help me understand what level of service my documentation supports. I carry these cheat sheet cards with me at all times and reference them all day long. As a hospitalist who performs E/M services almost exclusively, these cards have prevented me from under and over billing thousands of times over the last decade. However, for low level E/M codes, such as CPT® 99224, the risk table rarely comes into play as most history and physical documentation can support a level one subsequent observation care code without the need to calculate the correct level of medical decision making.

CLINICAL EXAMPLES OF CPT® 99224

With the purest interpretation of E/M rules in mind, what are some progress note documentation examples for a CPT® 99224, the level 1 subsequent observation care code? Although not required, many doctors use the subject, objective, assessment and plan (SOAP) note format for their documentation. A CPT® 99224 note could look like this:

S) No pain (1 HPI)
O) 120/80 80 Tmax 98.9 (three vital signs = one organ system)
A) Nothing needed
P) Nothing needed

In this example history (subjective) and physical (objective) meet the requirements to get paid for a 99224. Remember, the highest 2 out of 3 components determine the highest level of service for subsequent observation care visits. Do note that linking an ICD code to a CPT® code is required for all visits submitted for reimbursement from CMS. Therefore, most progress notes should provide at least one ICD code to clearly indicate a purpose for the visit. I suspect this is necessary to meet the reasonable and necessary threshold, unless that can be inferred from other chart documentation. Medicare doesn't want to pay for doctors to talk about the Superbowl with their patients. There must always be an approved ICD code linked with the CPT® code when billed to CMS.

I think it's always a good habit to include at least one ICD code, even though it's not technically required for E/M visits that can achieve compliance with history and physical components alone. Remember, the highest supported level of documentation for two out of three from history, physical and medical decision making on subsequent observation care visits will determine the appropriate level of service. For history, just one component of the HPI (character, onset, location, duration, what makes it better or worse etc.) or documentation of the status of three chronic medical conditions is required for this level one progress note. For physical exam, documentation of only one organ system is required and three vital signs counts as one organ system. That's not to say that a more thorough history or exam is not indicated. Only that E/M rules, if being graded by check marks for compliance, only require at least one bullet point for physical exam. Here is another clinical example of a SOAP note for a CPT® 99224 subsequent observation care:

S)Nothing
O) 120/80 80 Tm 98.6 (three vital signs = one organ system)
A)HTN-stable, no changes planned.
DM-stable, no changes planned (the status of three chronic medical conditions in place of HPI)
COPD-stable, no changes planned
P) Nothing

As you know, documenting the status of three chronic medical conditions can be substituted for the HPI. With that said, you only need to document three vital signs for physical exam if nothing else is relevant and your documentation is complete and accurate for CPT® 99224. Note also, this documentation can support a CPT® 99224 code with no "proof" of a face-to-face encounter. One could document vital signs from home and never see the patient and meet the criteria for a CPT® 99224, in a checkbox kind of audit way. Medicare, however, only pays for face-to-face encounters on E/M visits. I do not recommend billing for CPT® 99224 without a face-to-face encounter and documentation should support that a face-to-face encounter took place should the visit ever get an audit. Here is another clinical example of appropriate documentation for a CPT® 99224:

S) Nothing needed
O) 120/80 80 Tmax 98.6 (three vital signs = one organ system)
A) 1) HTN, controlled (one point for diagnosis)
P) Nothing needed

According to 1995 or 1997 guidelines, I can document a level one CPT® 99224 without ever asking the patient a question or laying hands on them, although, again, a face-to-face evaluation is always required. According to E/M guidelines, documenting the status of one chronic medical condition qualifies as low level risk in the decision making process. I have meet my requirements for 2 out of 3 areas by meeting requirements for physical exam (documenting three vital signs) and the decision making component (by documenting the status of one chronic medical condition). Remember, reasonable and necessary is always part of any evaluation.

There is a complicated table of risk that represents the last component of the decision making complexity and detailed on the CMS E&M guide linked through my hospitalist resource center above. What I have on my quick reference E/M coding card below only represents examples of moderate and high risk because one can achieve 99224 documentation requirements quite easily with minimal history and physical exam. I never use the risk table for a low observation follow-up progress note because I'm just not smart enough to memorize it. I only use the table of risk when determining moderate and high risk encounters. Here is another clinical example that meets documentation requirements for a CPT® 99224:

S)No Pain (one HPI)
O)Nothing
A)HTN, no change (one point for diagnosis)
P)Nothing

That's all you need folks. Documentation of two out of three areas at the lowest level needed. That means one HPI (no pain) and one physical exam (three vital signs) or one HPI (no pain) and low complex medical decision making (documentation of one stable medical problem such as HTN-stable), or documentation of physical exam (three vital signs) and low level medical decision making (HTN-stable).

Examples above represent the bare minimum required for a low level observation subsequent care visit in the hospital. This is not my patient population. That's why my total yearly level one documentation with CPT® 99224 is pretty low. Most patients in the hospital these days are much more complex than a level one of any service. Most hospital patients require an intensity of service much higher than a 99224. If a physician is frequently billing 99224, their patients should probably be at home surfing the internet and watching football.

DISTRIBUTION OF OBSERVATION SUBSEQUENT CARE CODES (99224-99226).

What is the distribution of CPT® code 99224 relative to other levels of service in this family of medical codes? CPT® group 99224-99226 is pretty new. CMS has only recognized these codes since 2011. However, CMS has data explaining how often 99224, 99225 and 99226 have been used. The graphic below was obtained from the 2011 CMS Part B National Procedure Summary Files data (2011 zip file) showing how many CPT® 99224 encounters were billed and the dollar value of their services for Part B Medicare. As you can see in the image below, E/M code 99224 was billed 78,264 times in 2011 with allowed charges of $2,149,541.13 and payments of $1,689,100.71.

National Summary Data File 2011 (99224-99226)

RVU VALUE

How much money does a CPT® 99224 pay in 2016? That depends on what part of the country you live in and what insurance company you are billing. E/M procedure codes, like all CPT® billing codes, are paid in relative value units (RVUs). This complex RVU discussion has been had elsewhere on The Happy Hospitalist. For raw RVU values, a CPT® 99224 is worth 1.12 total RVUs. The work RVU for 99224 is valued at 0.76. Make sure to review the complete list of RVU values on common hospitalist E/M codes. What is the Medicare reimbursement for CPT® code 99224? In my state, a CPT® 99224 pays just over $41 in 2016. The dollar conversion factor for one RVU in 2014 is 35.8043.

My E/M reference card below has taught me that I should be billing for the work I'm providing and it has taught me how to document appropriately. You can see many more of my E/M lectures by clicking through on the provided link. If you need bedside help determining what level of care you have provided, I recommend reviewing the pocket card described below.

LINK TO E/M BEDSIDE POCKET REFERENCE CARD POST

Click image for high definition view

Consumer Information for January 1, 2014

As the start of coverage for Qualified Health Plans in the Marketplace approaches, the Centers for Medicare and Medicaid Services (CMS) anticipates that some of the newly insured individuals will have questions about how to access healthcare services. CMS has posted information on Marketplace.cms.gov to address questions that consumers may have with the January 1 start of coverage through their selected health plan.

Individuals who have insurance for the first time or have new plans beginning on January 1 are likely to have many questions related to coverage, premiums payments, co-payments, and other issues and may need to reach their individual insurance plan. Below is information for consumers on how to access their health plans as well as education factsheets explaining how health insurance works.

What to know about seeing your doctor
http://marketplace.cms.gov/getofficialresources/publications-and-articles/seeing-your-doctor.pdf
What to know about getting your prescription medications
http://marketplace.cms.gov/getofficialresources/publications-and-articles/getting-your-prescription-medications.pdf
Appealing your insurers' decision not to pay
http://marketplace.cms.gov/getofficialresources/publications-and-articles/appealing-your-insurers-decision-not-to-pay.PDF
I signed up, but don't have health coverage. What should I do?
http://marketplace.cms.gov/getofficialresources/publications-and-articles/signed-up-but-no-coverage.pdf
Getting emergency care
http://marketplace.cms.gov/getofficialresources/publications-and-articles/getting-emergency-care.pdf
What you should know about early renewal of health coverage
http://marketplace.cms.gov/getofficialresources/publications-and-articles/early-renewal-of-coverage.pdf
What you should know about provider networks
http://marketplace.cms.gov/getofficialresources/publications-and-articles/what-you-should-know-provider-networks.pdf
Contacting your Health Plan’s Customer Service Phone Number (includes a link to a database containing the customer service phone numbers for all of the Qualified Health Plans) https://data.healthcare.gov/dataset/QHP-Customer-Service-Phone-Numbers/vryg-tdzf?)
http://marketplace.cms.gov/getofficialresources/publications-and-articles/contact-health-plan.pdf

Payments of Premiums
The deadline to sign up for coverage to start January 1st was December 23rd.

We want to remind you that consumers need to pay their premium directly to the insurance company in order to have coverage by January 1, 2014. Consumers can pay when invoiced by the plan, call the issuer to make payment, or pay online if the plan accepts online payment. All consumers have until at least December 31 to pay for coverage effective January 1, although some insurance companies have extended this deadline. Consumers should check with their insurance company to find out when their first premium is due in order for coverage to be effective January 1. Consumers should also confirm with the issuer that their first month’s premium has been received and that enrollment is complete.

Please note that once a consumer selects a plan through the Marketplace, it may take the health plan 48-72 hours to receive and process the enrollment, so please encourage consumers to continue to periodically check back with their selected health plan. The insurance company will also send plan information and an insurance card to consumers who have completed enrollment including payment of the premium.

https://www.healthcare.gov/how-to-have-the-best-experience-with-healthcare-gov/#part=5

https://www.healthcare.gov/how-to-have-the-best-experience-with-healthcare-gov/#part=6

(Reposted from the Champions for Coverage December 27, 2014 email)

New Year's Resolution Ideas For Nurses And Doctors (The Funny Version).

A new year is upon us. That means many folks will take time to reflect on the good and the bad over the past 365 days. It also means many people will be consumed by an overwhelming desire to make a New Year's resolution. For hospital doctors and nurses, every new year provides an opportunity for growth and improvement in their work environment. Turn on the television or read the internet this time of year and you are sure to find dozens of lists claiming to be the Top 10 New Year's Resolution Ideas of the Year. Well, I'm sorry to say, but you won't find any list like that here at The Happy Hospitalist. Instead, you'll find the Top 11 New Year's Resolution Ideas For Doctors and Nurses instead!

That's right folks, The Happy Hospitalist has interviewed tens of thousands of doctors and nurses and has captured the psychosis of hospital healthcare workers all across this great nation of ours. Some people may use New Year's Day as an opportunity to finally quit smoking or to lose weight or to spend more time with their family. Not healthcare workers. No. Sir. Ree. Doctors and nurses have no intention of walking that walk. For doctors and nurses, New Year's Day provides an opportunity to think up fresh new ideas on how to control the chaos inside those walls of your local hospital.

Top medical resolutions of the year!

In addition to the great content below, you can see hundreds of other original Happy Hospitalist healthcare related humor memes on Pinterest. You don't need to be a member of Pinterest to see them, but if you'd like to get notified whenever good humor is added, I suggest you add the Medical ecard board to your list of daily things to follow. Make sure to also join The Happy Hospitalist Facebook Page for daily comedy updates. Thousands of fans agree. One last thing. Many of these ecards are available for purchase on numerousMedical Humor Store available on Zazzle.com. The store is constantly expanding. Check back often as great content is added frequently.

What's your New Year's resolution idea? Leave a comment and let the world know how you plan to be better for the next 365 days! Now, please enjoy the crude medical humor version of New Year's resolution ideas for doctors and nurses.

"For my New Year's resolution, I decided to start with 1 mg of Ativan instead of 2."

"For my New Year's resolution, I started running... to get your Haldol."

"For my New Year's resolution, I started working out... side your room as much as possible."

"For my New Year's resolution, I decided to be more patient... while the Ativan kicks."

"For my New Year's resolution, I'm going to try a call light free diet."

"For my New Year's resolution, I'm going to be more thankful for solutions of propofol."

"Working New Year's Eve to take care of your drunk ass has always been a childhood dream of mine."

To view this ecard product selection, turn off the “content filter” function on the left hand side of the Zazzle store linked above.

"For my New Year's resolution, I'm going to be more empathetic. Or was it pathetic? I can't remember."

"New Year's resolutions suck. But not as much as my Yankhauer."

"For my New Year's resolution, I'm going to judge less and actually measure your Haldol dose."

"For my New Year's resolution, I decided to lose my bad attitude. Just kidding."

This post contains humor that may only be understood by some healthcare professionals. Read at your own risk.

HEALTH FOR ALL

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