Sunday, October 04, 2009

If Lawyers Billed Like Doctors

Imagine if lawyers had to bill like doctors:

Beginning July 1, 2010, under the Legal Billing Obfuscation Act of 2009, lawyers will receive their payments for services rendered after approval by a central US government Payment Distribution Authority (USPDA). To receive payment from the Authority plaintiff and defendant complaints must be coded and filed electronically using the International Classification of Legal Complaints, 10th edition (ICLD-10), copyright © 2009, American Bar Association and Legal Proceeding Terminology (LPT) codes, copyright © 2009 American Bar Association. The full publication of each of these codes will be available in print March 1st 2010 and in electronic form on DVD in July 2011.

To familiarize lawyers with the new coding scheme requested by the USPDA, a small sample for the complaint of “Spilling” is shown below:
  • Spilling 200
    • Spilling, Water – 210
      • Spilling, Water, Hot – 211
        • with blisters 211.1
        • without blisters 211.2
      • Spilling, Water, Warm – 212
      • Spilling, Water, Cold – 213
  • Spilling, Coffee - 240.1
    • Spilling, Coffee, Hot - 240.11
      • Spilling, Coffee, Hot, With Cream only - 240.12
        • with blisters - 240.121
        • without blisters 240.122
      • Spilling, Coffee, Hot, With Regular Milk only – 240.13
      • Spilling, Coffee, Hot, With 2% milk only – 240.14
      • Spilling, Coffee, Hot, With Skim Milk – 240.15
      • Spilling, Coffee, Hot, With Soy milk only 240.16
      • Spilling, Coffee, Hot, With Sugar only - 240.17
      • Spilling, Coffee, Hot, With Artificial Sweetner (of any type, including, but not limited to Nutrasweet, Spenda, Sweet ‘n Low) – 240.18
    • Spilling, Coffee, Hot, With Cream and Sugar 240.16
    • .
Pairing of improper complaint codes with legal proceeding codes will result in non-payment. “Up-coding” of legal proceedings shall constitute grounds for prosecution with some additional fines imposed by the IRS, as determined by the Office of Health and Human Services. For instance, pairing a legal complaint of “Spilling, Coffee, Hot, with blisters” to and of those of Divorce, same gender, living apart, male (or female) (shown below) will result in non-payment.
  • Divorce: 100-199
    • Between husband and wife 100.1
    • Between same gender couple, living together, male, 100.011
    • Between same gender couple, living together, female, 100.012
    • Between same gender couple, living apart, male, 100.021
    • Between same gender couple, living apart, female, 100.022
    • .
Valid code pairings for spillage include Accident codes (0010-0059), Assault codes (4400-4499), or Battery codes (5500-5599) provided documentation supports the requests for payment.



Marco said...

Don't forget different codes for decaf.


DrWes said...


Thanks for your inquiry to the USPDA. Decaf codes can be found under ICLD-10© codes 241.0, but only if caffeine levels fall below FDA guidelines for the term "decaffinated."


ShrinkingDoc said...

This cracked me up. Seeing this this way pointed out even more vividly how ridiculous our system is.

This kind of complex payment system for lawyers would't happen until "legal insurance" and government run "Legalcare" and "Legalcaid" become more widespread. I think the lawyers are smart enough not to take this kind of crap, unlike us docs...

The Happy Hospitalist said...

This is freaking hilarious

Evan Falchuk said...

Surprise, surprise: Lawyers write the laws, doctors don't!

Keep raising these issues, Wes. People need to hear more from doctors on what it's really like to practice medicine under well-intentioned rules designed by those who will never need to play by them.



Unknown said...

DrWes -- Funny, but you may be interested to know that this system already exists in the legal world, largely for outside counsel to insurance companies (particularly those other than health insurance companies) -- complete with bill reviews by computer programs, etc. As some physicians are now doing, most lawyers have opted for private pay relationships with most clients. Some lawyers have come around to flat fee or other alternative billing arrangements, which can work well for both lawyers and clients if well-designed. The legal payment system and the health care payment system have more similarities than you might think, and the legal "establishment" is undergoing its own dislocation these days, too. Bottom line: value-based purchasing isn't limited to the health care arena. Just sayin'.

DrWes said...


I am constantly amazed at what one can learn from a blog. Thanks for educating me.

I wonder if doctors will follow lawyers' lead? If Medicare didn't have the two-year restriction to dropping out of the system (placed there by whom?), I bet many more would have opted out from this craziness long ago.

Anonymous said...

I hope I won't still be laughing when you zap me tomorrow.

attilashrugs said...

1.I still am waiting the first Law School in India to prepare young Indian attorneys to practice in the USA. Then, after a certain threshold of foreign-trained attorneys have increased the supply of lawyers, there will be a real chance to introduce sweeping changes to The Legal Care Industry.
2.If doctors billed like lawyers? How about $5000 retainer and $325/hour?

attilashrugs said...

Thanx for the laugh.

But, what if doctors billed like lawyers? A 5K retainer from which charges of $325/hour are deducted until a new retainer is required?

When India opens its first American-Law Law School and churns out thousands of Bar ready attorneys, then we will see such legislation as USPDA. Foreign attorneys will be so well paid in comparison to their peers back home that they would slavishly accept almost any degree of bureaucratic bullying. Hey, I wonder if that was The Plan in Medicine?
Then the "Legal Care Providers" can be marched into a USPDA.