Drive Through Vicodin Clinic

My new ER has a little window on the side like the drive through at a McDonald's, and I was joking with my friend today that I could use it as a drive through vicodin clinic. Then I saw that Dr. Whitecoat linked to this article about a Stanford University experiment which pilots the concept of drive through triage.

That caused me to erect a capitalist tent of sorts, as I pondered that one could easily make a fortune with such an enterprise. I can already bill a 99283 ER visit and a level 1 facility fee without ever touching the smelly patients, now they don't even have to come in the door!

Procedure Code: CPT 99283 – Emergency department visit for the evaluation and management of a patient, which requires these three key components: an expanded problem focused history, an expanded problem focused examination, and medical decision making of moderate complexity. Usually, the presenting problem(s) are of moderate severity.

According to ACEP guidelines, any medical condition requiring prescription drug management supports a 99283 charge. So by definition, if I determine that your headache requires a prescription for a couple dozen vicodin and your credit card has enough remaining balance to cover my charges, then it was nice doing business with you. Have a nice day. But how much do I need to document to support the charge?

Honestly, if you're paying cash or credit, it doesn't really matter. I don't take Medicare, so the CMS isn't going to review your chart. But just to be thorough, I can document a level 3 history and physical without you having to unbuckle your seatbelt. Here's how:

Just give your order, I mean your history, to the nurse via our conveniently covered and HIPAA-compliant ordering kiosk behind the building. There will be helpful menus to guide you through your chief complaint and HPI. Just pick one answer from each box to describe your pain (location, description, duration, severity, exacerbating factors, relieving factors). When you pull up to the window, the nurse will visually inspect you for signs of distress and place a small device on your finger to measure your pulse and blood pressure while your credit card is swiped.

I'll be at the next window, where I will visually inspect you for alertness and lack of distress, a normocephalic and atraumatic head examination, eyes without redness or discharge, normal respiratory effort and lack of retractions, a quick evaluation of your affect and mood, and the briefest of cranial nerve examinations and speech evaluation.

That's all there is to it! In five minutes, you're on your way to the pharmacy with your prescription in hand, and I'm three hundred dollars richer. We both win.

Coming soon to a neighborhood near you.