A surgeon I know recently removed a patient’s thyroid gland.  Attached to the gland was a lymph node.  Fortunately for the patient, the pathologist found the lymph node normal and the patient’s only inconvenience other than this surgery will be taking thyroid replacement for the rest of her life.  All seemed to be going well until the surgeon was contacted by one of the “not for profit” hospital administrators.  What follows is their conversation.

Surgeon: Hello. (on phone)

NFPHA (“not for profit hospital administrator):  Doctor, we need to talk about the lymph node dissection you did on Mrs. X.

Surgeon:  I didn’t do a lymph node dissection on Mrs. X.

NFPHA: Yes you did.  There was a lymph node on the pathology report.

Surgeon:  Yes.  But that doesn’t mean I did a lymph node dissection. 

NFPHA:  It does in my book.  I need for you to change your dictation to indicate that you did a lymph node dissection as this will allow us to bill a much higher amount for the case.

Surgeon:  You don’t understand.  I didn’t do a lymph node dissection.  That is a radical and separate procedure from the thyroidectomy that was done.  That there was a lymph node attached was fortuitous but not an indication that a lymph node dissection was done.

NFPHA: You don’t understand how much money is at stake.

Surgeon:  Listen to me carefully now. This conversation is over.  If you ever ask me to dictate a procedure again that I didn’t do, in order to fraudulently “upcode” a surgery, I will contact the family concerned and several good lawyers that I know and inform them of what you are doing.  Do you understand?

Dial tone.

As I’ve said before, I couldn’t make this stuff up if I had to.  Beginning to see who is behind the high price of health care?

Oh.  One more thing.  Do you think the administrator would have even asked if this surgeon had been his employee? 

G. Keith Smith, M.D.