What if a Hair Stylist Documents and Bills Like a Physician...

Few days ago, I went to Washington DC to work on Senate Bill 1989 which would codify IRS statue to allow use of HSA (health savings account) dollars for periodic physician fees. This would clear up a debate for direct primary care as to whether or not you can use HSA monies for monthly physician fees. In the process of this work I figured I should probably try to look like a grown up. So I saw my new hair stylist for a good cut and color.

Sitting in the chair at the salon, I let my mind wander. I can’t wear my glasses while all of the color sets in so it’s one of the few times I’m not emailing, calling, texting or reading. And I started realizing, what my hair stylist does is awfully similar to what I used to do when I was a physician in the traditional system. My stylist works on an appointment basis (that she confided she has minimal control over at the big salon where she works). She’s pressured to see/do more and have two chairs going at a time. She bills on a fee-for-service basis (paid only when people get a service that only she does), has to listen, then assess, then ‘diagnose’ then make thoughtful educated decisions to help me have the outcome I’m saying I desire. All very, very similar.

What if...

As my mind wandered, I thought: what if my hair stylist had to document, code and bill like I used to have to do? She would be wildly inefficient and I suspect sapped of all professional joy (did I say that). So, somewhat spoof, somewhat truth, here’s what life might be like if a hairstylist had to document their work the way physicians now do:

Salon Scheduling Note: Needs grey coverage, looking for new stylist.

CC: Julie is an energetic 39-year-old female who comes in today desiring improved coverage of her grey, reddish brown highlights in anticipation of Fall, and with questions about length and current hair cut. She states she is going to Washington DC next week for work on a medical political action committee and would like to look more professional. Her prior stylist whom she had seen for many years left practice entirely and became a real estate agent. She comes in today to establish care.

Review of Situation: Julie’s states she does not normally fix her hair. She states she’s a “wash and wear kind of girl.” In general she wakes up 20 minutes after she should, rapidly washes her hair and goes to work. She does choose to wash her hair daily which she understands strips the color quickly. She’s tried sulfate free shampoos but does not stick with them. Otherwise she’s not really tried anything else for her grey or for color maintenance. In general she prefers long hair and notes if it is cut to shoulder length it takes at least 4 years to grow again.

Past Hair History:

1) A ‘hairless baby’ according to what she’s been told.

2) Wildly uncontrolled hair per her mothers report with frizz for most of her childhood. Hair was medium brown then dark brown in childhood. No routine hair care other than provided at home until college.

3) Has had one perm which resulted ‘Michael Jackson’ hair that was, in her words, unmanageable for a decade.

4) Episode in college requiring emergency intervention: used OTC “Black Cherry” from Natural Choices which resulted in deeply violaceous purple hair. This did not wash out for months. Since that time she has had increased sensitivity to all attempts to darken her hair and states she has a strong preference not to do so for fear of looking like a Villain.

Allergies/Sensitivities: Denies any skin conditions or reactions to dye or coloring agents.

Current Products:

1) Cannot remember the name —“Whatever’s on sale at Costco”

Physical Exam:

Gen: Tall white female casually dressed who does arrive four minutes late but is very pleasant, rational and cooperative. She has a picture of Sandra Bullock from 2009 to show what she would like her cut to look like.

Hair length: Her hair is cut to mid-sternal line and is pulled back with a simple (hair-breaking) rubber band.

Hair texture: When down it is notably fine but thickly textured with approximately 1” x 1” gray stripe in the right fronto-temporal region.

Hair color: The majority of her hair is a deep chestnut brown with some yellowish highlights at the ends. She has innumerable split ends. Her hair appears to have been cut about 4 months ago.

Assessment: 39 year old female here to establish care desiring cut, color and highlights.

H00.00 New patient, needing color, initial encounter

704.2 Grey hair, resistant to coloring, initial encounter

L67.1 Variations in hair color due to multiple coloring treatments, needing highlighted, subsequent encounter

L67.2 Dark hair sensitive to color, subsequent encounter

L82.4 Split ends, recurrent, needing remedied through cutting, subsequent encounter

R68.89 Near 40 year old adult female, desiring improved appearance, subsequent encounter

L67.8 Knotting of hair due to product choice, subsequent encounter

Plan/Procedure Note:

After assessment we discussed all of her options including doing nothing, shaving her head, giving up and going totally grey, referral to an expert colorist or color and cut here today.

She consented to wash, color, highlight and cut here today.

After verbal informed consent, Aveda “Sensuous Auburn” was applied throughout her stringy hair and left in place for 30 minutes. Around the temples Aveda “Embers of Fall” was applied in 16 places for highlights. After 30 minutes, grey was assessed, still present and color was left on another 10 minutes.

She was then moved to the washing station where Aveda “Essences of Esteem” shampoo was applied, liberally, and massaged into the scalp. This was rinsed with water that was verified to be below 120 degrees F. Copious amount of conditioner was applied and rinsed after 2 minutes.

Hair was gently brushed, blow dried and cut to desired style. She did not look like Sandra Bullock.

There were no complications.

She expressed satisfaction with her treatment today.

She was advised to follow up in 4 weeks for repeat color and expressed understanding. She is aware it is very challenging to maintain her hair as desired when she does not keep routine appointments.

More than 145 minutes were spent face to face on this encounter.


99204, New patient, complex intervention, hair assessment and cut

99356, Prolonged encounter

99355, prolonged encounter, additional 30 minutes

-25 modifier, coloring applied

-50 modifier, bilateral highlights applied by same provider

Dr. Julie is a Board Certified Family Physician who continues to love the work of being a doctor. She believes the administrative demands of modern medicine have marginalized the primary care doctor’s role and are eroding the physician-patient relationship. She founded sparkMD in 2014 to take back her relationship with her patients and to empower herself to be the doctor she set out to be.