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Prostate Exam, Pap Smears, Stool for Occult Blood
Good for the patient - good to increase your reimbursement.
I cannot believe that physician’s would send female patients out of their office, and into the office of a gynecologist for a pap smear. It happens every day! Their explanation is “I do not have time.” My answer is – if you are any kind of businessman, whose job is to help the patient, you had better find the time to do pap smears in your office.
I do not have to tell you how to do a pap smear – you already know the procedure. What you should be doing is the best. The “thin” prep pap smear, like we do. Much more diagnostic.
Pap smears and vaginal cultures for infection, plus stool for occult blood and complete pelvic evaluations are stepping-stones to other procedures. If you find a cystocele, rectocele, or uterine procidentia, it is an impetus for the patient to be followed carefully – yearly.
If you find big nabothian cysts, it leads to destruction of the cysts with your Ellman hyfercator machine, right in the office. You get the reimbursement –not the gynecologist.
If the exam shows cervical erosion, you can cauterize and destroy it with your Ellman hyfercator, and get proper reimbursement that should go to you and not someone else. If there is evidence of infection – do a vaginal culture, and get paid for it. If the patient has hemorrhoids, these must be watched and referred appropriately.
We do not “do” non-thrombosed hemorrhoids in the office. Thrombosed hemorrhoids are a different matter. We do them routinely in our office with an Ellman Hyfercator Machine and get excellent reimbursement. If the patient is positive for occult blood on stool exam, this sets the stage for colonoscopy done by you in your office.
If the cervix and uterus are displaced, and the patient has painful intercourse, it is time to do a pelvic ultrasound in your office, on your machine with payment going to you, not another facility.
One of the reasons we do so much gynecology is because we have learned that patients do not understand their pathology unless you let them see their pathology. I use a four- inch mirror that has a handle on it. When I say you have a nabothian cyst or a cystocele or a rectocele, or the cervix and uterus are not midline, they can see what I am talking about and then they will understand.
When they can see all the discharge in the vaginal vault, then they understand where the discharge is coming from and how it contributes to nabothian cystic disease, discharge, and odor. They get the picture.
Now let us talk about prostate exams. Get the PSA two-weeks before or after a PSA blood test so the results will not be skewed. We never do a yearly prostate exam without examining for hernia, testicular and penile status. We never do a prostate exam without doing a stool for occult blood. In other parts of this article, I have already explained which tests are generated by a positive stool for occult blood.
When you file, you can file for a med/surg visit, OMT, heat massage, traction, and prostate-genitalia exam. This last testing is reimbursable. So what do you have? Office call, OMT, complete prostate/genitalia exam. (Learn the code to file for this.) Bottom Line: You should be doing all of the tests I have recommended, in this article, in your office, with your equipment. You will have made the patient happy and your reimbursement will be substantial.
