Time, cost, and adolescent patients
Bill Marshall, MD
I suggest having a separate waiting area for teens if you have a large adolescent practice. This is not always practical, of course. If you can't have such an area, move each adolescent into a room as soon as possible and have some interesting materials there to keep him occupied, in addition to having him fill out questionnaires, etc.
As for billing: Pediatricians need to quit moaning about reimbursement for youth visits. Document your time and charge for it! Internists do just fine, and adolescents represent the geriatrics of pediatrics! Remember: If you document your face-to-face time you can charge at a higher level. There are now codes for counseling time, for example. Also remember that you do not always have to do everything in one visit. If you're not sure how to code, invest in taking a CPT coding seminar dedicated to pediatrics.
For another view, read "Office-based care of adolescents: Part 1 - Creating a teen-friendly office" by David Rainey, MD, in Adolescent Health Update, October 2003 (vol. 16, no. 1). This is a publication of the American Academy of Pediatrics Section on Adolescent Health; if you can't find it at your local medical library, you should be able to obtain it from the AAP. There is a nice bibliography and resource list included-and, yes, Dr. Rainey also references the HEADS interview as being integral to a friendly approach to teens.
John M. Goldenring, MD, MPH