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The Surgeon's Hearse

The Surgeon's Hearse

Originally posted to a forum of Surgical Center billers and administrators (I was in a weird mood that day); re-written as a letter to Medicare Services (to help work in some explanations) and published on

Hello, Center for Medicare Services, I need to report an incident in our surgery center.

Actually, I need to know if I need to report this incident. And if I need to report it, how do I report it. I don’t know if there are any V, G, CPT, ICD-9, ICD-10, PQRI, PQRS or any other acronym soup codes you guys got for what just happened.

Get to the point? Hey, don’t you get snippy with me! I didn’t make these regulations. You guys put doctors in jail if they split an $85 office visit fee. Yet do you see any conflict of interest in a surgeon owning a funeral home? No.

And some of these privacy regulations you guys got. We can get hit with all kinds of fines if a bus driver's employer finds out about his visual field impairment. But is there anything to stop the funeral home from letting its surgeon-owner scan customer lists for cross-sell opportunities?

Yeah, you get the picture. We got a surgeon that owns a funeral home doing cases in our surgery center. No, he’s actually a pretty good surgeon. Not too many infections, complications, or accidental deaths to report over the past couple of years.

But he does have his eccentricities. Like every now and then, he takes his other company's car to work. And while no patient has ever said anything to us, you’ve got to wonder what goes through their minds when they see a hearse in a parking space marked "reserved for surgeon."

Today, it got weird.

Our surgery center has courtesy car, a limo we use to drive patients back and forth when they don’t have family or friends with cars to bring them in for surgery. Today, our limo broke down. So the surgeon, he's a genuinely nice guy, absent-mindedly tossed his keys to our driver and said, "Here, use mine."

Now, Charlie's a pretty good driver (not too many visual field impairments to speak of), but he tends to do exactly what he's told. GPS says, "turn right," Charlie turns right. Doctor says, "use mine," Charlie’s off to ferry surgery patients back and forth in a shiny black hearse.

Of course, when our by-the-book administrator heard that we were using a vehicle not owned by the surgical center, she yelled, “not so fast.” She has to know what liability might be. She calls the insurance company and they tell her it was okay to use the surgeon’s "car", but it would be better if the patient didn't sit up front with the driver.

So the surgeon performs a successful cataract surgery on elderly patient and discharges her from the surgery center. As she's walking towards the parking lot, she says, "What blues! What reds! I thought I'd have to die and go to heaven before I'd see colors like this again."

Then she turns the corner and there's Charlie, perfect in his limo driver pose, holding open the back door of the hearse, inviting her to step in.

So here are my questions.

One, the broken hand this woman sustained when she fainted—do we have to report this as a post-operative surgery complication?

Two, the ride Charlie gave her to the emergency room (in the bed of the hearse), do we have to report that as an emergency transfer from outpatient surgery center to the hospital?

And finally, since this was the doctor's hearse, will this impact his Physicians Quality Reporting Incentive and if so how do I code this on the forms?

Thank you for your assistance in this matter.

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