An American Sickness: How Healthcare Became Big Business and How You Can Take It Back

by Elisabeth Rosenthal

Coding creep grew ever bolder—until it made no sense at all. If needle sticks and eye infections are coded as level 5, what was a crushed chest from a car accident or a heart attack? A Center for Public Integrity (CPI) investigative series in 2012 found a huge increase between 2001 and 2008 in Medicare billing for levels 4 and 5 visits among emergency room patients who were sent home, from a quarter to nearly half of all patients. Meanwhile, the proportion of level 2 visits decreased by about half, to just 15 percent. More than 500 of the 2,400 hospitals in the database billed the two most expensive codes for more than 60 percent of patients. Dr. Donald Berwick, a former Medicare administrator, told the CPI that he believed most doctors were not breaking the law, just “learning how to play the game.”