CPT Update 2007: (new codes)
100121 Intraoperative Intercession, first 90 minutes
100122 Intraoperative Intercession, each additional 60 minutes
[author's note: apologies for the gargantuan length of this thing. It's taken on a life of its own. And yes, I know this is not what the prayer study showed. That's the point. Enjoy!]
Dr. DeFACCto's friend was getting steamed.
"I'm sorry, Dr. Herzmesser, but your first pump case will have to wait till 10:30." The OR scheduling secretary looked apprehensive.
"Barb?" He turned to the senior OR nurse, who had been a fixture at Fictional Medical Center about as long as he. "What in the blue blazes is this about?" (He had been asked to 'tone down his language,' and goddammit, he was gonna try.)
"Well, Sammy, our backup PI, you know, the professional intercessor, called in sick." Barb alone among the nurses enjoyed first-name privilege with Herzmesser, a testament to her longevity or possibly to her knowing where the bodies were buried. So to speak. "Yeah, I know. Maybe he'll stay home and pray for himself. Anyway, the other one won't be freed up until the first case is done in room 5."
"The hell with prayer, Barb! This is crazy; I'm going ahead anyway." Now even the head nurse looked concerned. "If we don't start soon, we'll be here till effen midnight." So much for toning down his language.
"Uh, actually, Dr. Herzstenker -- by the way, I'm Phil Pinchpenny, the new cardiovascular product line administrator." An impossibly young-appearing guy in a suit, sporting a fine head of executive hair worn over a very earnest face had stepped forward. "It was decided in the cardiac prayer meeting last Thursday that, what with the big PR campaign by Downtown General and all, we would only do open heart cases without realtime intercession in life-threatening emergencies. I'm sure you remember their tagline: 'If you go to the wrong heart center, then you don't have a prayer.' Our CEO is determined that we'll outpray them and the sisters at St. Superior by next quarter, or else."
"Well, I'll be sure and order my wimple, but really..."
"I'm quite serious, Dr. Herzsenker, and that's why you should really start coming to the weekly prayer meetings. It's hard to demonstrate to the staff our committment to this new, evidence-based, therapeutic modality without the support of physicians such as yourself." He emphasized "evidence-based" as though to chide the physician: This isn't some touchy-feely BS; it's actual Science.
"Well, who's paying for these pray-ers, anyway? There's no third-party coverage."
"Actually, the Blues have promised to look into it in their next updates. That reminds me, would you be willing to accompany me, as our senior CV surgeon, to present our institutional data at the statewide Medicare Coverage Review meetings next week?"
Now Sammy really did feel like a Heart-sinker, picturing himself in a semi-darkened room saying, 'As you can see, this graph shows Reoperation Rates pre- and post-Intercession, with a p-value of...' or, better yet, 'As you can see, at least at our center, prayer has no effect on postop atrial fibrillation, but renal failure is a whole different story.' He shook his head.
It had all started with the publication of that study a year or so ago. Although many skeptics had challenged it, its methodology seemed to be ironclad. After investigators at a variety of international research centers had replicated its findings, the medical community had grudgingly come to accept its central conclusion: anonymous intercessory prayer reduced major postoperative complications following open-heart surgery by about 15%. That doesn't sound like such a big deal, but considering that the average major complication was estimated to cost hospitals and insurers $25,000, it didn't take a big decrease to make administrators sit up and take notice. First the faith-based hospitals, with their prayer infrastructure already in place, and then the university centers, pretty soon all the heart centers jumped on the bandwagon. There was a bit of a hitch at the government hospitals, but the ACLU publicly professed neutrality, so long as patients had the ability to 'opt out' from being prayed for.
Next came the first wave of outsourcing. Certain monasteries set up up Intercession Centers, which could serve dozens of clients at once and offer a truly professional level of service. All you had to do was fax the patient's billing information at least thirty minutes prior to surgery and they handled the rest, gradually weaning down the frequency and intensity of intercession over the next 48 hours or until the patient left ICU, whichever came first. Of course, here in the Southeast there was widespread distrust of any Catholic-affiliated prayer centers, but several multi-denominational, predominantly Baptist, centers had sprung up to fill the need.
Dr. Herzmesser still shook his head as he reminisced. He had always been a laborare est orare kind of guy, but he wanted to heed the message being delivered by his trusty tools, the randomized clinical trial and his own -- God-given, he presumed -- common sense. Here they seemed to be in conflict. He realized that Barb and Phil were still there, looking at him.
"Sorry, Phil, got a root-canal scheduled that day. Maybe another time, OK?" He turned to Barb, "Guess I'll see you guys back around 10:30 then." And he headed off to the doctors' lounge.
[to be continued]