Atlas of Primary Care Procedures, 1st Edition


Diagnostic and therapeutic procedures are an integral part of the practice of primary care medicine. Office procedures can provide the patient with valuable health benefits in a familiar and comfortable location. Procedures provided by the primary care physician can enhance the doctor-patient relationship, and result in rapid decision making by reducing fragmentation in health delivery. The benefits of procedures in primary care medicine can be most clearly demonstrated in rural areas, where the time and expense of travel to tertiary medical centers may represent a serious barrier to patient care.

This atlas is designed to provide primary care healthcare providers with a step-by-step instructional reference in common office procedures. The information incorporates practical suggestions developed by the authors during their nearly 50 years of teaching procedural medicine. Over 700 illustrations have been added to enhance the clarity of instructions, and to provide the reader with visual cues. Providers-in-training and teachers should benefit from a deeper comprehension of techniques incorporated into these procedures. Seasoned practitioners will appreciate the concise summary of each procedure's CPT® coding, pitfalls, and complications. The 72 procedures covered in this atlas range from the simple (cerumen removal) to the complex (colonoscopy). These procedures incorporate the vast majority of skills required of primary care practitioners, and far exceed the number performed by most practicing physicians.

Each chapter begins with an overview of background information about the procedure. Indications and contraindications (both relative and absolute) are listed, providing a framework for evaluating patients being considered for a particular procedure. Illustrations and their accompanying legends provide sequential instructions in the performance of the procedure. Bulleted pitfalls are included to demonstrate common errors or difficulties that practitioners historically have encountered. The coding section includes suggested CPT® codes, descriptors, and reported 2002 average 50th percentile fees charged for the selected codes. The instruments and materials section provides examples of ordering information (phone numbers and web site addresses) for obtaining the materials mentioned in the chapter. The bibliography section includes references used in the chapter, as well as information of interest when considering a procedure.

Modern health delivery offices and clinics must report services to third-party payers using national coding resources. The CPT® codes are developed by the American Medical Association, and generally accepted by most national insurers. The codes listed in each chapter are suggestions; other codes may be selected that more appropriately describe the procedure performed or services rendered. In addition, certain insurers may incorporate local reporting rules that take precedent. The reader should constantly update their knowledge of annual coding changes.

This atlas includes 2002 average 50th percentile fees for CPT® codes that are listed. This information is derived from the 2002 Physicians' Fee Reference, Yale Wasserman DMD Medical Publishers, Milwaukee, Wisconsin. The Physicians' Fee Reference® information contained in the Atlas has been added to help the reader understand the medical marketplace and are not recommended fees. These fees are provided to demonstrate national information, and not to serve as a recommendation for practices to set a specific charge for services.This annual survey of fees provides invaluable national data on fees that can help practitioners interact with the health delivery system. It is not uncommon for medical practices to be unfairly accused of “overbilling” by third-party payers who have set reimbursement levels exceptionally low. Being equipped with national fee data can help medical practices to counter these inappropriate accusations. Starred procedures are small surgical procedures that involve a readily identifiable surgery, but include variable preoperative and postoperative services. Because of the indefinite associated services provided before and after the surgery, the typical package concept does not apply. Starred (*) procedures include just the service listed; associated preoperative or postoperative services may be billed separately.

The resources listed in the Instruments and Materials section are not comprehensive. Materials may be included because historically they have demonstrated effectiveness or ease of use in primary care practices. Many of the instruments are listed because they provide accurate and cost-effective information. Readers may use materials that they believe are superior; the authors welcome comments or suggestions for future editions of the atlas.

No book can replace experience. When learning any new procedural skill, it is recommended that the practitioner receive proctoring from someone skilled in the procedure. Precepted experience is strongly urged for more complex procedures to reduce patient complications and medicolegal liability. Formal procedural training courses also are available through specialty societies (such as the American Academy of Family Physicians), medical interest societies (such as the American Society of Colposcopy and Cervical Pathology), or local or regional medical societies. It is hoped that this reference will serve as an invaluable additional resource in the provision of high-quality procedural services.