Recognizing the importance of practitioners' paperwork

Developing skills in non-clinical office work is important for all practitioners.
Developing skills in non-clinical office work is important for all practitioners.

 The number 99213 is not just a zip code in Washington — it represents a billing code that I have come to understand is the lifeblood of primary care. When I made the decision to become a nurse practitioner, I did it, as I've written before, to improve myself and to help my community. Noble goals, no doubt. What I was not aware of was the amount of drudgery involved in being altruistic.

If you are anything like me, you'll say to yourself that you are not interested in these non-clinical things; it's not what I signed up for. Well unfortunately, it is these things that make an office run and ensure we get paid. While in clinicals, I would listen to the other providers and staff talk about how much they had on their desktops or in baskets or whatever system they used for tracking the never ending deluge of behind-the-scenes paperwork that makes an office run. I would wonder to myself when we would learn about this in school. I'm starting to realize that this is going to be one of those on-the-job learning experiences that we all enjoy so much. I can see it now, "Congratulations, Sean, on becoming an NP, and welcome to your new job here. This is your desk, and you are already a week behind on authorizations, you are 15 minutes late for your first appointment, and it is your week to feed Zog."

My FNP program has spent some time discussing billing codes, and we have to accurately bill our charts from our clinical rotations. However, it does not prepare us for actual office life. This has begun to concern me as I draw nearer to the completion of this program and begin to look for jobs in earnest because salary and reimbursement tend to be important topics. As I went back and looked at the cases I've seen so far and how I had coded them, I realized how such a tedious task becomes so important. How do the folks on TV medical dramas have so much free time? How are they not getting buried in a never-ending avalanche of office chores and threats from fire-breathing office and billing managers?

Looking ahead to going into practice, I have dreamed of saving lives, treating chronic patients, having an exam named after me, and just being the best FNP I can. I am now also realizing that to be able to accomplish all of these things, I will need to be a good steward of the office as well. As a nurse, I have always been paid by whomever I have worked for. Now as a nurse practitioner I will be the one generating revenue, and others will be responsible for my efficiency and dedication to not only the patients but the paperwork that each encounter will create. Maybe one day a TV medical drama will be entitled, "99213," and it will be about a group of providers struggling to always be caught up and out of the office by closing time.

Sean P. L'Huillier, BSN, RN, CEN, is an emergency department nurse currently enrolled in Georgetown University's School of Nursing and Health Studies Family Nurse Practitioner Program.

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