Physician coding for mental illness reimbursement and the need for mental health parity

Many patients with anxiety and depression initially seek treatment from their primary care physicians. Changes in insurance coverage and current mental parity laws, make reimbursement for services a problem. This has led to a coding dilemma for physicians seeking payment for their services. This study seeks to determine first the frequency at which primary care physicians use alternative coding, and secondly, if physicians would change their coding practices, provided reimbursement was assured through changes in mental parity laws. A mail survey was sent to 260 randomly selected primary care physicians, who are family practice, internal medicine, and general practice physicians, and members of the Harris County Medical Society. The survey evaluated the physicians' demographics, the number of patients with psychiatric disorders seen by primary care physicians, the frequency with which physicians used alternative coding, and if mental parity laws changed, the rate at which physicians would use a psychiatric illness diagnosis as the primary diagnostic code. The overall response rate was 23%. Only 47 of the 59 physicians, who responded, qualified for the study and of those 45% used a psychiatric disorder to diagnose patients with a primary psychiatric disorder, 47% used a somatic/symptom disorder, and 8% used a medical diagnosis. From the physicians who would not use a psychiatric diagnosis as a primary ICD-9 code, 88% were afraid of not being reimbursed and 12% were worried about stigma or jeopardizing insurability. If payment were assured using a psychiatric diagnostic code, 81% physicians would use a psychiatric diagnosis as the primary diagnostic code. However, 19% would use an alternative diagnostic code in fear of stigmatizing and/or jeopardizing patients' insurability. Although the sample size of the study design was adequate, our survey did not have an ideal response rate, and no significant correlation was observed. However, it is evident that reimbursement for mental illness continues to be a problem for primary care physicians. The reformation of mental parity laws is necessary to ensure that patients receive mental health services and that primary care physicians are reimbursed. Despite the possibility of improved mental parity legislation, some physicians are still hesitant to assign patients with a mental illness diagnosis, due to the associated stigma, which still plays a role in today's society. ^

MEDICINE MAN IN TEXAS

The author George (Georgia?) Plunkett Red was the wife of Samuel Clark Red (1861-1940). Dr. Red was the son of Texas pioneer physician Dr. George Clark Red. Dr. Samuel Clark Red was “the county physician of Harris County, one of the organizers of the Harris County Medical Society, a fellow of the American College of Surgeons, and president of the Texas Medical Association.” Not much is known about the author, but given her husband’s position and family history, it can be surmised that she was interested in history and had access to some of the children of other pioneer medical families. There is a brief bibliography for each of the chapters. Part Two of the book consists of biographies of physicians from Texas Counties. Merle Weir, "RED, SAMUEL CLARK," Handbook of Texas Online (http://www.tshaonline.org/handbook/online/articles/fre09), accessed December 10, 2012. Published by the Texas State Historical Association.

The History of Pathology in Texas

The History of Pathology in Texas is the study of the changes of disease in Texas from the frontier days to the 1990s. Marilyn Miller Baker wrote the book for the Texas Society of Pathologists. The book was published in 1996 with a forward by Vernie A. Stembridge, MD, the Ashbel Smith Professor and Chairman Emeritus of Pathology at the University of Texas Southwestern Medical Center at Dallas. The book covers the story of pathology from the "performance of crude autopsies" on the frontier through the emergence of bacteriology and immunology and beyond.

A History of Organized Medicine in Harris County, Texas

The item was written by the Historical Committee of the Harris County Medical Society and signed on October 28, 1948. A brief history of medicine in Texas is given before the focus shifts to the Harris County and Houston area. Information on the early years is taken from various sources such as Pat Ireland Nixon’s The Medical Story of Early Texas and the writings of George Plunkett (Mrs. S. C.) Red. Significant information comes from the Minutes of the Harris County Medical Society.

William Osler: Original Papers 1898-1906

Part 1: 1898-1899 On Chronic Symmetrical Enlargement of the Salivary and Lachrymal Glands, 1898 Leprosy in the United States, with the Report of a Case, 1898 An Acute Myxaedematous Condition, with Tachycardia, Glycosuria, Melaena, Mania and Death, 1898 On some of the Intestinal Features of Typhoid Fever, 1898 Cerebro-Spinal Fever, 1898 The Arthritis of Cerebro-Spinal Fever, 1898 In Memoriam, William Pepper, 1899 After Twenty-Five Years, 1899 The Diagnosis of Typhoid Fever, 1899 Interstitial Processes in the Central Nervous System, 1899 Part 2: 1900 The Home Treatment of Consumption, 1900 On Splenic Anaemia, 1900 The Chronic Intermittent Fever of Endocarditis, 1900 A Case of Multiple Gangrene in Malarial Fever, 1900 Latent Cancer of the Stomach, 1900 On the Study of Tuberculosis, 1900 Fatal Angina Pectoris without Lesions of the Coronary Arteries of a Young Man, 1900 On the Advantages of a Trace of Albumin and a Few Casts in the Urine of Certain Men above Fifty Years of Age, 1900 Part 3: 1901-1902 Congenital Absence of the Abdominal Muscles with Distended Hypertrophied Urinary Bladder, 1901 Intermittent Claudication, 1902 On the Diagnosis of Bilateral Cystic Kidney, 1902 On Amebic Abscess of the Liver, 1902 Note on the Occurrence of Ascites in Solid Abdominal Tumors, 1902 Amebic Dysentery, 1902 Notes on Aneurism, 1902 William Beaumont; a Pioneer American Physiologist, 1902 Part 4: 1903 On the Educational Value of the Medical Society, 1903 On obliteration of the Superior Vena Cava,1903 Chronic Cyanosis, with Polycythemia and Enlarged Spleen: A New Clinical Entity, 1903 The Home and its Relation to the Tuberculosis Problem, 1903 Unity, Peace, and Concord, 1903 Typhoid Fever and Tuberculosis, 1903 Part 5: 1904-1906 Ochronosis, 1904 The “Phthisiologia” of Richard Morton, M.D., 1904 On the Surgical Importance of the Visceral Crises In the Erythema Group of Skin Diseases, 1904 Aneurysm of the Abdominal Aorta, 1905 Back Notes

William Osler: Original Papers 1907-1919

Part 1: 1907-1908 The Royal Medical Society of Edinburg, 1907 On the Library of a Medical School, 1907 On Telangiectasis Circumscripta Universalis, 1907 A Clinical Lecture on Abdominal Tumours Associated with Disease of the Testicle, 1907 A Clinical Lecture on Erythraemia, 1908 Vienna after Thirty-Four Years, 1908 Endocardites Infectieuses Chroniques, 1908 Part 2: 1909 Chronic Infectious Endocarditis, 1909 What the Public Can Do in the Fight Against Tuberculosis, 1909 Annual Oration on the Occasion of the Opening of the New Building of the Medical and Chirurgical Faculty of the State of Maryland, May 13, 1909 The Medical Library in Post-Graduate Work, 1909 The Treatment of Disease, 1909 Part 3: 1910-1911 The Pupil Symptoms in Thoracic Aneurysm, 1910 The Lumleian Lectures on Angina Pectoris, 1910 Certain Vasomotor, Sensory, and Muscular Phenomena Associated with Cervical Rib, 1910 An Address on the Hospital Unit in University Work, 1911 Sulle Telangiectasie Emorragiche Ereditarie, 1911 Transient Attacks of Aphasia and Paralyses in States of High Blood Pressure and Arterio-Sclerosis, 1911 The Pathological Institute of a General Hospital, 1911 Part 4: 1912-1914 An Address on High Blood Pressure: its Associations, Advantages, and Disadvantages, 1912 Specialism in the General Hospital, 1913 Syphilis of the Liver with the Picture of Banti’s Disease, 1913 An Introductory Address on Examinations, Examiners, and Examinees, 1913 The Medical Clinic: a retrospect and a Forecast, 1914 Part 5: 1915-1919 Remarks on the Diagnosis of Polycystic Kidney, 1915 The War and Typhoid Fever, 1914/15 The Cerebro-Spinal Fever in Camps and Barracks, 1915 Remarks on Arterio-Venous Aneurysm, 1915 Nerve & “Nerves”, 1915 Intensive Work in Science at the Public Schools in Relation to the Curriculum, 1916 Creators, Transmuters, and Transmitters, 1916 Annual Oration on the Campaign Against Syphilis, 1917 The First Printed Documents relating to Modern Surgical Anaesthesia, 1918 Observations on the Severe Anaemias of Pregnancy and the Post-Partum State, 1919 Typhoid Spine, 1919

Phylogeny of the Echini, with a revision of Palaeozoic species.

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Letter from William Croswell to James Scott, 1803 November 1

One-page letter from Croswell to Captain James Scott, Master of the Boston Marine Society, that accompanied Croswell's work on lunar observations.

Commonplace book of Hector Orr, 1789-1804

Hector Orr began recording entries in this commonplace book during his first year as a student at Harvard and continued writing in the volume sporadically until 1804. The entries written while he was a student, from 1789 to 1792, include themes written on the following topics: Time, Discontent, Patriotism, Virtue, Conscience, Patience, Avarice, Compassion, Mortality, Self-knowledge, Benevolence, Morning, Anger, Profanity, Bribery, Autumn and Winter, Hermitage, Conscience and Anticipation. He also wrote detailed entries about the forensic disputations in which he and his classmates participated, explaining both the affirmative and negative positions. One of these disputations involved discussion of the Stamp Act, which was then quite recent history. Orr's entries about the disputations list the names of students involved and specify their position in the argument.

Account books of Thomas Cradock, 1786-1818 (inclusive)

Account books listing patients, medicines administered, and fees charged by Dr. Thomas Cradock (1752-1821), primarily in Maryland, from 1786 to 1818. In addition to recording names, Cradock occasionally noted demographic information, the patient's location, or their occupation: from 1813 to 1816, he treated Richard Gent, a free African-American man; in 1813, he attended to John Bell, who lived in the Foggy Bottom neighborhood of Washington, D.C. Cradock further noted if the patient was a slave and the name of his or her owner. He would also administer care on behalf of corporate entities, such as Powhatan Factory, which apparently refused him payment. He also sometimes included a diagnosis: in the cases of a Mr. Rowles and Mrs. Violet West, he administered unspecified medicines for gonorrhea at a cost of ten dollars. Commonly prescribed drugs included emetics, cathartics, and anodynes. Cradock also provided smallpox vaccination for his patients. He accepted both cash and payment-in-kind. Tipped into the first volume is an envelope containing a letter from the Medical and Chirurgical Faculty of Maryland to Mrs. Thomas Craddock in 1899 requesting a loan of portrait of Dr. Thomas Craddock [sic]. The three volumes also each contain an index to patient names.

Notification from William Cutler to the selectmen of Cambridge, Massachusetts, that Dr. Philip Brukowitz and wife were inhabiting his father's house in Cambridge, 1758 April 25

Single page notification addressed to the selectmen of Cambridge, Massachusetts, dated 25 April 1758, in which William Cutler writes that he took into his father’s Cambridge house as tenants Dr. George Philip Brukowitz and his wife, from Woburn, Massachusetts. After the Boston smallpox epidemic of 1721, the town of Cambridge enacted a requirement in 1723 that no resident would receive or admit any non-resident family into their homes for the space of a month without informing the town selectmen. The penalty for failing to do so was twenty shillings.

Small Pocks, 1775-1779 (inclusive)

Ledger containing accounts of smallpox inoculation by Dr. John Jeffries (1745-1819) at Rainsford Island Hospital in Boston, Massachusetts, from June to July 1775; at a West Boston smallpox hospital in July 1775; and in Halifax, Nova Scotia, between 1776 and 1779. The accounts include dates, names, ages and physical condition of patients, and details regarding the method of delivery. Among the patients he inoculated was his son, John, at Rainsford Island Hospital on 14 June 1775.

Account books of William Aspinwall, 1776-1812 (inclusive)

Two account books containing entries noting patients visited, fees charged, and small accounts of Dr. William Aspinwall (1743-1823) in Boston and Brookline, Massachusetts, from 1776 to 1812. He includes sections for "Women's Accounts" with charges generally rendered to their husbands or other male relatives. There is also an entry charging the town of Cambridge, Massachusetts, four dollars and fifty cents for medicines and attendance to a boy who contracted smallpox.