Part B Insider (Multispecialty) Coding Alert

Denials and lawsuits lurk, plus some states outlaw poor penmanship

Illegible handwriting isn't just a charming quirk - carriers can deny your claims if they decide your supporting documentation is unreadable. And if a pharmacist misreads a prescription and dispenses the wrong drug, you could face malpractice suits and licensure issues.

The Institute for Safe Medicine Practices issued a white paper in 2000 on the danger of handwritten prescriptions, which details the costs of unreadable scrawls. In October 1999, a court ordered a Texas cardiologist to pay $225,000 to the family of a patient who received Plendil instead of Isordil because the pharmacy misread the physician's unreadable prescription.

Carrier claims reviewers have a rule of thumb that if two out of three reviewers can't read a document, it's officially unreadable, according to Quinten Buechner with ProActive Consultants in Cumberland, WI. If you insist your document is legible, you can try transcribing it, but the transcription must have the same number of words "as the mess you looked at in the first place."

Some states may even punish doctors who write illegibly. "The state of Wisconsin has a law that puts the license in jeopardy if the notes are illegible," notes Buechner. Also, Florida state law requires legible prescriptions.

Doctors in denial: If your doctor refuses to admit to a problem, try bringing him a note that he wrote a month earlier. Chances are the doctor won't be able to read the note either, says Buechner. Also, other doctors in the practice can tell the physician that his scribbles are putting the practice at risk because nobody would be able to read the records in his absence.

In addition, there's an objective test for bad handwriting: take notepaper with holes in the sides and position one of the holes over one letter in the doctor's notes. If the doctor can't tell you what letter of the alphabet that is, it's a sign of bad handwriting, says Kate Gladstone with Handwriting Repair in Albany, NY.

Solutions: Once your doctor admits to the problem, then you can try investing in other solutions, such as electronic medical records or a dictation service. "There are a couple of programs you can dictate into and they will create a record from them," notes Buechner, but these are still in the teething stages. Doctors can learn to use a Dictaphone and dictate their records in the hallway from one exam room to the next, notes Buechner.

Technological solutions are prone to failure, however, so encouraging physicians to improve their writing is still best, says Gladstone. She teaches handwriting seminars for physicians, where she encourages them to use a blend of cursive and print that she calls italic, which is quicker and more legible than regular writing.