I received a notice today from the dreaded REVIEWERS (somewhat related to The Providers, the three bodiless brains who ran the planet Triskelion on an early Star Trek episode, althought these are brainless bodies who review the arcane system of numbers that we physicians must enter into our billing records in order to collect ever-diminishing amounts of money from Medicare). I had written a two-page note about a patient who came in for a "complete physical" and underwent such, with a typical classic history of chief complaint, present illness, past history, family history, social history, review of systems, and then a physical exam which included head to toe exam. Along the way, it turns out she did have a chief complaint, foot pain, which we dealt with during the examination and afterward. The bill reflected the preventive service of a physical exam (coded V70.0, in case you want to know) and a foot pain, and appropriately charged for both.

The REVIEWER claimed that this could not have been a preventive service, a complete physical exam, because there was a complaint! Apparently one is permitted to bill for a physical exam only on patients who have no complaints! A preventive service should find no disease or it can't be paid for! Well, I guess it could have been paid for if I had written an entirely separate note concerning the minor problem found.

Even more annoying, this patient was not a Medicare patient! She was much too young. But insurance companies in general, having discovered a new way to harass physicians and possibly along the way avoid paying a bill, have adopted the ridiculous, totally irrational rules of Medicare in such regard.

Clearly, any intelligent person could have made sense out of the situation and realized that a complete physical exam had been scheduled, performed, and billed for, and also that a single minor problem had been identified during the physical exam and had been appropriately dealt with and billed for, but NO! They had to play Little Tin God and find some excuse to justify their existence. I have written back with this analogy: Suppose you take your automobile to the garage for a tuneup, which the mechanic performs, and he also finds a burned-out taillight bulb, which he replaces. Does his replacement of the taillight bulb mean that he didn't perform the tuneup? I can't wait for the reply.

Jehosephat, are these bureaucrats totally irrational or what? And there are some of you out there, mostly Democrats, I know, who want to put them in charge of your medical care.

Even more annoying, these REVIEWERS are supposed to be on my side! They are supposed to ensure that I am paid properly.

And worse than that, Medicare has decided to cut payments by 10.1 percent to physicians next year. That means that I wouldn't even recoup my costs of dicating another note to justify the physical exam, paying for transcription, proofreading it, and paying secretarial help to resubmit the form. The entire set of regulations is designed primarily to annoy physicians so much that they throw up their hands and abandon the process, thus forfeiting payments to which they are entitled.

And way too many fools out there are clamoring to entrench these government functionaries and their henchmen ever deeper into the bowels of medical care. It is the equivalent of a bureaucratic colonoscopy without any lubricant.