To the Editor:

HCFA and a band of AMA bureaucrats have made it impossible to take care of any complicated Medicare patients (see “Exam Documentation Just Got Harder,” October 1997). There is no way anyone can find the time to take a history, perform the 18-bullet-point exam, write it down and hope to recover anything even close to overhead expenses. Essentially, this means shipping any complicated patients to someone else who can charge for a consultation and thus be partially compensated for the work it takes to perform and document all the minutiae HCFA is being allowed to demand. For the AMA to prostitute itself to this task and not demand that suitable adjustment be made for primary care reimbursement is unconscionable.

I presume that about 3 percent of medical practitioners will be going to jail in the next year and for the foreseeable future if they try to bill for a 99215. This level of visit has become unbillable in my opinion. These latest revisions in the Medicare documentation guidelines are an idiotic maneuver performed seemingly to disenfranchise most of the primary caregivers in the United States. The AMA CPT Editorial Panel has succeeded where the RBRVS failed.