PCPs, Communication and Upcoding for Profit

Recently a patient I treat with buprenorphine told me that his primary care physician had prescribed a “Z-sleeper” (eszopiclone, zolpidem, zopiclone) for insomnia. The patient assured me that he had told the doctor I am a psychiatrist treating him for addiction. It seems that every few weeks a patient tells me of a primary care with similar knowledge, and without attempting to contact me to coordinate care, attempts to address a psychiatric complaint by whipping out the prescription pad instead of picking up the phone to coordinate care.

What motivates this?

My first thought: Primary cares regard psychiatrists as “therapists” who do not -- or cannot -- prescribe medications. I cannot blame them for that.

Second thought: They do not have time, probably a valid point to some degree.

Final thought: By addressing a symptom from a different system they get to upcode the CPT and increase their reimbursement with very little added investment of time or effort. I have mixed feelings. A lot of patients cannot find or afford a psychiatrist. A primary care physician deserves adequate reimbursement for treating a psychiatric condition. But when someone with more expertise has already assumed that responsibility, the patient’s best interest dictates that coordination of care should take precedence over monetary concerns.

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