Dear Senator Frist,

As a physician (thoracic surgeon, to be specific), you are undoubtedly very familiar with the coding systems under which all medical conditions and procedures are categorized.  You recall, I’m sure, that the 9th Revision of the International Classification of Diseases, Clinical Modification, commonly abbreviated as ICD-9-CM, codifies both disease states and hospital-based medical procedures.  Services, activities, and procedures performed by physicians, whether in clinical offices or in the hospital, are classified under two closely related coding schemes, the Healthcare Common Procedure Coding System (HCPCS) and the American Medical Association’s Current Procedural Terminology, or CPT.

As you know, these codes are central to the healthcare system, determining who gets reimbursed by insurers and how much they are paid.  They define and describe what goes on in hospitals and home health agencies, doctors’ offices and clinical laboratories, nursing homes and dental offices, podiatrists and mental health clinics, pharmacies and rehabilitation facilities.  When you examine a patient to determine her fitness for surgery, your bill must display ICD-9-CM diagnosis code or codes appropriate to the CPT codes for the services you’ve carried out.  So does the hospital bill if you decide that the patient needs to be admitted.  So does your bill for the surgery you perform to save her life with your expertise.  So do the bills for the cath lab, pharmacy, operating room, anesthesiologist ... all healthcare services and activities.  Without CPT codes and ICD-9-CM codes, and HCPCS codes, it isn’t a medical procedure.

Which brings me to the Partial-Birth Abortion Ban Act of 2003.  Senator Frist, I would appreciate it if you, as a physician, would be so kind as to point out to me the specific ICD-9-CM, CPT, and/or HCPCS codes that pertain to the procedure or procedures you and your colleagues call “partial-birth abortion”.  I find no such references to medical terminology in the text of Public Law 108-105.  Nor can I locate the term “partial-birth abortion”, or anything remotely similar, in my (admittedly cursory) examination of the three medical coding systems currently in use in the United States.

Now, one wouldn’t expect a chest surgeon to be fully knowledgeable about the details of the practice of obstetrics and gynecology.  Still, even a surgeon should know enough medicine to realize that “partial-birth abortion” is in no sense whatsoever a meaningful medical term.  Many sources argue that what is implied by the term is the rare ob-gyn procedure called dilation & extraction.  But that is merely supposition; in fact, while Nebraska legislators were drafting the law (overturned by the US Supreme Court in 2000 in Stenberg v. Carhart) upon which this one is based, the legislators defeated an amendment that would have specified the real, narrowly-defined medical term instead of the deliberately misleading one chosen by the anti-choice forces.

I might note that the PBA Ban law reads more like a legal brief, perhaps an attempted rebuttal to the Supreme Court’s reasoning in Stenberg, than legislation as I understand it.  I’m no more of a lawyer than you are, Senator, so I don’t know whether the people who wrote this thing have a leg to stand on—the new law has already been enjoined in three District Courts, and the same nine Justices sit on the Court now as were there in 2000. 

The buzz is that the failure to include a “health of the mother” clause in this law, typical of the draconian Republican legislative agenda, is just one of the reasons that this law will not stand.  I hope that’s the case, but unfortunately pessimism is always warranted in the land of Bush.

Comments

One of the radio reports I heard said it could be found in Medline’s dictionary; I just searched and found 100 references in PubMed, but none are definitions as such.

The Republicans are better at semantics, I must admit; with this term and “death tax,” our side is losing.

Yes, I agree completely about the success of the Republican PR machine.  They’re absolutely uncanny in the way they have been able to frame the debate in their chosen terminology.  I’ve written about it a number of times, including an entire entry on the topic way back in January.

On your first point, the “Medline dictionary” is merely an online “Merriam-Webster“ that includes medical-type terms in general use.  In other words, it’s nothing more than a circular self-reference to their own misleading terminology. 

As you note, PubMed, the real medical reference search engine, gives plenty of references (I got 64 by using the phrase partial-birth), but they are all—every single one of them—news clips, editorials, and/or non-medical publications.

Simply stated, the term partial-birth abortion does not exist in the medical community.

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