Coding A Morning

52 Comments / Being a Doctor, Best Of, Humor, The Healthcare Problem / By

PLACE OF OCCURRENCE, HOME ICD-E849.0
6:00 AM

Alarm goes off.  Hit snooze button. CIRCADIAN RHYTHM SLEEP D/O IRREG SLEEPWAKE TYPE ICD-327.33

6:30

  • Alarm goes off for third time.  Ready to hit snooze button, but knee in ribs from wife prevents more snooze button procrastination.  CONTUSION OF CHEST WALL ICD-922.1, ADULT MALTREATMENT UNSPECIFIED NEC ICD-995.8
  • Feeling tired, go to make a pot of coffee. CAFFEINE ADDICTION ICD-304.40
  • Fill bowl with Lucky Charms and start eating. UNSPECIFIED NUTRITIONAL DEFICIENCY ICD-269.9, HYPERGLYCEMIA ICD-790.29

6:45

  • Realize that coffee pot needs to be turned on for it to make coffee. ATTENTION DEFICIT DISORDER, ADULT ICD-314.00, LISTLESSNESS ICD-780.79
  • Turn coffee pot on and wander to check email, blog, Twitter, Facebook, etc. OBSESSION ICD-300.3
  • Daughter wanders in with dazed expression and blanket draping shoulders.  STUPOR ICD-780.09
  • Speaks only in soft, irritated grunts. SELECTIVE MUTISM ICD-313.23, E/M 99212 ENCOUNTER, ESTABLISHED, BRIEF

7:00

  • Bring cup of coffee to wife in bed.  She moans when she looks at the clock.  Another morning headache.  E/M 99215, ENCOUNTER, ESTABLISHED, HIGH COMPLEXITY; OTHER COMPLICATED HEADACHE SYNDROME ICD-339.44, OTHER SPEC MENOPAUSAL&POSTMENOPAUSAL DISORDER ICD-627.8
  • Wake up other children who return evil glares for gentle nudging.  CHILD EMOTIONAL/PSYCHOLOGICAL ABUSE ICD-995.51; E/M 99214, ENCOUNTER, ESTABLISHED, MODERATE COMPLEXITY
  • Walk to shower and get frustrated at towels not hung up. ANGER ICD-312.00

7:25

  • Shower, shave, and get dressed.  LACERATION, FACE ICD-873.40
  • Walk downstairs to find kids sulking and wife frustrated.  UNDERSOCIALIZED CONDUCT D/O UNAGRESSIVE UNSPEC ICD-312.10
  • Try to give her advice.  COUNSELING FOR PARENT-CHILD PROBLEM UNSPECIFIED ICD-V61.20
  • Wife glowers.  MARITAL&PARTNER PROBLEMS UNSPECIFIED ICD-V61.10
  • Say: \”We have to leave in five minutes!\” in an angry voice.  PROBLEMS WITH COMMUNICATION ICD-V40.1
  • Children glower. FAMILY DISRUPTION D/T PARENT-CHILD ESTRANGEMENT ICD-V61.04
  • Wife sighs and chides for the tone of voice.  COUNSELING FOR PARENT-BIOLOGICAL CHILD PROBLEM V61.23; E/M 99215, ENCOUNTER, ESTABLISHED, HIGH COMPLEXITY

PLACE OF OCCURRENCE STREET AND HIGHWAY ICD-E849.5

7:40

  • Finally in car with daughter, driving to school.  CRITICAL CARE INTERFACILITY TRANSPORT EA 30 MIN CPT-99467
  • Daughter still not talking more than mumbles.  OBSERVATION CHILDHOOD/ADOLES ANTISOCIAL BEHAVIOR ICD-V71.02
  • Turn on iPod and play music daughter doesn\’t like.  PASSIVE-AGGRESSIVE PERSONALITY DISORDER ICD-301.84

7:55

  • Daughter dropped off, running frantically to not be tardy.  Angry that \”we are always late.\”  UNSPEC EMOTIONAL DISTURBANCE CHLD/ADOLESCENCE ICD-319.3
  • Don\’t attempt to explain that it is seldom the chauffeur\’s fault.  HEARTBURN ICD-787.1
  • Nod and smile.  FEAR OF WOMEN ICD-300.29
  • Drive to work.  AGGRESSION ICD-312.00

OTHER SPECIFIED PLACE OF OCCURRENCE ICD-E849.8

8:15

  • Arrive at work, greeted by a long list of unsigned charts that materialized mysteriously overnight.  DEPRESSION, SITUATIONAL, ICD-300.4
  • Go to kitchen and pour another cup of coffee – mega jumbo size.  CAFFEINE EXCESS ICD-305.90
  • First patient status is \”arrived\” even though appointment is for 8:45.  Sigh loudly.  AVOIDANT PERSONALITY DISORDER ICD-301.82
  • Check email, blog hits.  DEPENDENCE ON OTHER ENABLING MACHINE ICD-V46.8

8:45-12:00

  • See patients, answer phone messages, assess lab and x-ray results, and periodically check email, blog, etc. ADVERSE EFFECTS OF WORK ENVIRONMENT ICD-V62.1,
  • Talk with drug reps who explain advantages of drugs which have been out for many years. AMNESIA, PSYCHOGENIC ICD-300.12; E/M 99213 ENCOUNTER, ESTABLISHED, LOW COMPLEXITY
  • Get another mega jumbo cup of coffee. PREMATURE ATRIAL CONTRACTIONS ICD-427.61;  POISONING BY CAFFEINE ICD-969.71; EROSIVE GASTRITIS ICD-535.40

Note: This is a caricature, not my real life.  My wife and kids are generally very nice to me and I do like my work.

52 thoughts on “Coding A Morning”

  5. Doctor D

    It’s a bit scary how much this reminds me of a Happy Hospitalist post. Except Happy would have ended with a rant about how he won’t get any reimbursement for his morning’s work.

  6. Doctor D

    It’s a bit scary how much this reminds me of a Happy Hospitalist post. Except Happy would have ended with a rant about how he won’t get any reimbursement for his morning’s work.

  7. medrecgal

    ROTFL from this outpatient coder, who’s probably seen most, if not all, of those ICD-9 diagnoses in the course of even one shift! Leaves me thinking you’d be unlikely to be responsible for any of the 300.00 that’s sometimes generated by the crazy changes that are constantly going on…it’s only the providers who think we’re a waste of time and actually behave that way who cause me some 796.2 (elevated BP without dx of hypertension) . And your 873.40 should also have an associated E code, in this case, E920.8, accident caused by other specified cutting instrument. I like that slightly warped sense of humor that comes out when you’re posting about coding, too!
    And for the record, you’re NOTHING like Happy Hospitalist…you may talk about the headaches generated from coding (784.0 if it’s otherwise unspecified), but you don’t have that underlying tone of disdain and condescension that he can sometimes exhibit.

  8. medrecgal

    ROTFL from this outpatient coder, who’s probably seen most, if not all, of those ICD-9 diagnoses in the course of even one shift! Leaves me thinking you’d be unlikely to be responsible for any of the 300.00 that’s sometimes generated by the crazy changes that are constantly going on…it’s only the providers who think we’re a waste of time and actually behave that way who cause me some 796.2 (elevated BP without dx of hypertension) . And your 873.40 should also have an associated E code, in this case, E920.8, accident caused by other specified cutting instrument. I like that slightly warped sense of humor that comes out when you’re posting about coding, too!
    And for the record, you’re NOTHING like Happy Hospitalist…you may talk about the headaches generated from coding (784.0 if it’s otherwise unspecified), but you don’t have that underlying tone of disdain and condescension that he can sometimes exhibit.

  21. Abbi

    Why’d you choose 99215 instead of a 99214? Did it take THAT long and was it REALLY that complex?? LOL! 😉 You make me laugh while on bedrest and housebound until my 3rd child is allowed to come! 😉

  22. Abbi

    Why’d you choose 99215 instead of a 99214? Did it take THAT long and was it REALLY that complex?? LOL! 😉 You make me laugh while on bedrest and housebound until my 3rd child is allowed to come! 😉

  23. Kathy Ellis

    Your note, “This is a caricature, not my real life. My wife and kids are generally very nice to me and I do like my work” may not be the exact truth. Maybe you are dealing with 293.81 (psycotic disorder w/ delusions in conditions classified elsewhere) or maybe with just something simple like Reactive Confusion, 298.2. Whatever it is, that’s okay, we all deal with something. Me? I just struggle with 315.1

  24. Kathy Ellis

    Your note, “This is a caricature, not my real life. My wife and kids are generally very nice to me and I do like my work” may not be the exact truth. Maybe you are dealing with 293.81 (psycotic disorder w/ delusions in conditions classified elsewhere) or maybe with just something simple like Reactive Confusion, 298.2. Whatever it is, that’s okay, we all deal with something. Me? I just struggle with 315.1

  25. Rob

    Mathematics disorder? Since you work with me I won’t say anything mean in a comment (prefer face to face), but I do think the psychotic one has a right ring to it.

  27. Rob

    Mathematics disorder? Since you work with me I won’t say anything mean in a comment (prefer face to face), but I do think the psychotic one has a right ring to it.

  31. Jame Norrell

    Being a hospital coding supervisor I for one am very impressed with your coding knowledge. It’s always amazing to me how many physicians I run into on a daily basis who do not know the first thing about coding much less know the actual codes themselves. Most outsource their coding/billing and hope for the best. Coding = reimbursement….sounds like you have it under control!

  32. Jame Norrell

    Being a hospital coding supervisor I for one am very impressed with your coding knowledge. It’s always amazing to me how many physicians I run into on a daily basis who do not know the first thing about coding much less know the actual codes themselves. Most outsource their coding/billing and hope for the best. Coding = reimbursement….sounds like you have it under control!

  35. SeaSpray

    I’m sorry … but I just have to say something off topic here ..unless of course you have a code for it …but as I was scrolling back up (chuckling even now as I type in the dark – again..), I couldn’t help but notice the big Llama picture ..the one where he’s looking out the car window and cracked up – again and I’ve concluded that llamas are extremely funny looking creatures when placed in abnormal (for them) situations. 🙂

  36. SeaSpray

    I’m sorry … but I just have to say something off topic here ..unless of course you have a code for it …but as I was scrolling back up (chuckling even now as I type in the dark – again..), I couldn’t help but notice the big Llama picture ..the one where he’s looking out the car window and cracked up – again and I’ve concluded that llamas are extremely funny looking creatures when placed in abnormal (for them) situations. 🙂

  37. David

    This is great stuff…..your best comedy post yet!! Those level 4 & 5’s are everywhere I always say. I actually work for a physician that (in his spare time) presents a program teaching docs and staff how to code and document more efficiently and confidently. I need to figure a way to incorporate something like this in his presentation. That would be a hoot!….and keep everyone awake!

  38. David

    This is great stuff…..your best comedy post yet!! Those level 4 & 5’s are everywhere I always say. I actually work for a physician that (in his spare time) presents a program teaching docs and staff how to code and document more efficiently and confidently. I need to figure a way to incorporate something like this in his presentation. That would be a hoot!….and keep everyone awake!

  39. Cospo

    Ho Ho Ho!! Fell over laughing and nearly wet my pants! Coding was part of my job as a clinical coordinator for a home health agency/nurse registry. What fun. This was a scream, Rob, a true stroke of genuis! You really need to write a book collecting your funniest stuff. This is number One!

  40. Cospo

    Ho Ho Ho!! Fell over laughing and nearly wet my pants! Coding was part of my job as a clinical coordinator for a home health agency/nurse registry. What fun. This was a scream, Rob, a true stroke of genuis! You really need to write a book collecting your funniest stuff. This is number One!

  41. Carrie (@LizzPiano)

    All I can say is thank you. You are by far one of the most creative people I know! 🙂 (And that’s saying a lot…coming from someone who spent 5 years in music school!)

  42. Carrie (@LizzPiano)

    All I can say is thank you. You are by far one of the most creative people I know! 🙂 (And that’s saying a lot…coming from someone who spent 5 years in music school!)

  49. G. Fire

    Now I understand why one of the local newspapers recently ran an ad for an 8 hour (or maybe even longer) class in medical coding.

  50. G. Fire

    Now I understand why one of the local newspapers recently ran an ad for an 8 hour (or maybe even longer) class in medical coding.

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