Letters To The Editors

Etiology matters: A great teacher and a simple test

The evening before attending a presentation on headaches at the ACP-ASIM Annual Session in Philadelphia, I read "Why etiology matters" [April 12], the story of how a CME lecturer identified a mysterious condition afflicting a young surgeon. This master diagnostician was Harvard Medical School neurology professor, Martin Samuels—the speaker I was to hear the next day.

Obviously in great demand, Samuels delivered his program, "Headache: Diagnosis and treatment" twice that morning—three consecutive hours of teaching! And, as documented in your story, he answered questions from the crowd that gathered around after his presentations.

Your article enhanced what I learned from Samuels' lecture. Thanks so very much for an outstanding magazine.

Joshua Grossman, MD
Johnson City, TN

I realize that "Why etiology matters" was not presented as a case study, but I can't help asking a clinical question: With all the lab work done on the patient, including a muscle biopsy, didn't anyone order an EMG? This simple electrophysiological test could have confirmed the presence of motor activity consistent with a diagnosis of this young resident's disease: Isaacs' neuromyotonia.

Peter B. Saadeh, MD
New York City

A tip on saving scanned data

Here's a word of advice for anyone who wants to do as suggested in the Computer Consult article, "Drowning in documents? Scan 'em!" [April 12]. Scanning EOBs, forms, and photocopies of insurance checks into your computer is an excellent idea—as long as you're able to access the information later when you need it. To make sure that you can, save your scanned documents in a nonproprietary format such as .pdf, .tif, or .jpg—especially if you intend to destroy the hard copies. That way, even if the company that developed your scanning software goes belly up, you'll still be able to access your files.

Matt Levin, MD
Pittsburgh

Editor's Note: A product manager for PaperPort, the scanning software used by the medical practice featured in our article, confirmed that it is a good idea to save your files in a nonproprietary format. For example, if you're using PaperPort, you can save black and white images as .tif files; color or grayscale as .jpg. However, the trade-off for safety is that some of the features of PaperPort work only with PaperPort's Max files. The same is true of features on other proprietary software. The best bet probably is to save copies of the files in a nonproprietary format as backup and actually work with the manufacturer's files.

Coding: A time frame for suture removal

In "Low-level codes can bring in high revenue" [Coding Consult, April 12], your coding experts suggest using office visit code 99211 when a nurse removes sutures.

However, some carriers assign a global period to certain procedures, and the suture removal generally falls within that time frame. If you bill a "nurse visit" within that time frame, it would be denied.

Jennifer Nelson
Skowhegan, ME

Editor's Note: For more on this issue, see "Coding Consult" in this issue.

Edited by Liz O'Brien,
Associate Editor

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Letters to the Editors.

Medical Economics

2002;13:12.