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Of Plumbers and Doctors

Sep 26, 2019 2:58 pm

One of the water pipes in my house broke. I had to turn off the water to the house. Due to some upcoming plans, I called a plumber emergently to fix the pipe and restore the water to our house.  It took the plumber about an hour to fix the pipe. Since this was a plumbing emergency, he billed me $130 for his labor and expertise. Plumbing parts and his travel time were extra. 

The next day I went to the hospital. I was on my two weeks of General Medicine inpatient attending and we were admitting that day. An elderly man was admitted through the emergency room meeting sepsis criteria caused by a urinary tract infection due to an indwelling catheter for prostate issues. He was resuscitated with fluids and received antibiotics. He complained of chest discomfort necessitating a chest radiograph, EKG, and troponins. The patient was finally stabilized, labs reviewed, and notes written. There is no doubt that the medical complexity and severity of this patient’s illness merits a CPT code of 99223. The time spent with this patient and his family easily exceeds the 70 minutes required to meet this code, if one was to bill on time alone. 


Following this patient’s successful hospital discharge several days later, it struck me that I had participated in improving an emergent “plumbing” situation similar to the plumber who had fixed the plumbing emergency in my house. What does billing a 99223 mean? Medicare assigns a work relative value unit (wRVU) of 3.86 to an encounter that is billed with this CPT code. It is anticipated that the physician has spent approximately 70 minutes total time on the ward rendering care. Of note is that the value of one wRVU is $35.89. That means I was paid $138.53  (3.86 wRVUs) for my participation in helping to resolve this patient’s emergency.

This is comparable to what I paid my plumber for his one hour of work. Hmmm…I guess that’s fair?

Sterling West, MD
(3 Posts)

Sterling West, M.D. is Professor of Internal Medicine at the University of Colorado School of Medicine in Aurora, Colorado. He was the previous Rheumatology Fellowship Program Director for over 30 years. He has published over 100 articles and is editor of the book, Rheumatology Secrets.

Rheumatologists’ Comments

Dr Arthur Weinstein

| Sep 28, 2019 3:21 pm

Sterling Your plumber graduated from high school, went on to take take technical courses at a community college, apprenticed for a few years and then passed and exam. He certainly deserves his fee. On the other hand, one might argue that your fee is adequate given all the enjoyment you get from your profession and the adulation and respect you get from hospital administrators and medical insurers. Art
Good point Art. My father in law was a plumber and I worked for him when I was in high school so I do not begrudge what the plumber charges and gets paid. However, the rates CMS set for their wRVU is a different story. Hope you are doing well, Sterling

Christopher Adams MD

| Sep 29, 2019 9:47 am

Sterling, are you compensated as an internist or as a rheumatologist for your work? Becker Hospital review for 2015 (latest available to me on the web) suggests your wRVU should be over $50 for your work as a rheumatologist. (…) Being familiar with you and your work for the past 30+ years, I would suggest you are worth a heck of a lot more than the average!
Thanks for your kind words. When we are inpatient General Medicine attending we are compensated as an internist taking care of an inpatient (similar to a hospitalist) not as a subspecialist. All the best, Sterling

Jon Paul Scully

| Dec 14, 2019 1:25 pm

Sterling, and Weinstein, This is incredibly interesting! Sterling, you probably Because of your experience as a plumber recognize the correlation of both industries but now years removed and from an MD point of view. I have a customer who is an Eye Surgeon; he had a master shower faucet and hall bath faucet seized due to rusty water. He was so intrigued by what he called my surgical process; which included rubber gloves, a drill bit, and other. My wife is an immunologist. So, while I don't need to work, I do and I charge $125 for the first hour and I feel, I know, what I do is exactly the same as what a medical practitioner does: diagnose. Over time I have realized I will ask the similar types of question that my Doctor will ask me. I can't avoid noticing the comments from Dr Weinstein; relevance? The difference in education between a medical doctor and a master plumber is that the MD Residency is heavily regulated and watched. I don't take home $125 after expenses. My waiting room is 839 sq mi, is not always full, and my patients price negotiate and are skeptical. But after 20 years, I’m a master diagnostician and also enjoy the adulation. and listen for Zebras. Scully.

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