Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Doctors now diagnose in code. ICD code, that is.

Frederick Gandolfo, MD
Physician
August 16, 2015
205 Shares
Share
Tweet
Share

“Hi, it’s Dr. Smith, are you taking consults today?” the voice on the other side of my short-range hospital phone said.  I recognized the caller’s name as one of the new hospital doctors, known as hospitalists.

“Of course,” I said, “What have you got?” I guess some groups have a specific doctor for the day “take” the consults.  If I am in the hospital, I am always taking consults.

“Great,” the hospitalist says. “I have a 67-year-old female with chronic systolic heart failure and diabetes type 2 (uncontrolled) who presents with acute blood loss anemia likely from upper GI bleed.  She was given two units of blood in the ER, and we wanted to get you on board.”

As I write down the patient’s name and room number, I try to remember what it was like before everyone spoke in billing codes.  “Acute blood loss anemia” was not something that I was taught about specifically in medical school, or even residency.  We learned about bleeding ulcers, and bleeding varices, and bleeding arteriovenous malformations, and diverticular bleeding, and a bunch of other diseases that cause bleeding.  We learned about iron-deficient anemia, and pernicious anemia, and sickle cell anemia, but there was not even a page in the textbook about “acute blood loss anemia.” Could I handle the management of this rare and unusual disease?

In reality, “acute blood loss anemia” is just another medical billing phrase that was forced into our medical notes and has somehow creeped into our day-to-day vocabulary.  The explanation is as follows: The hospital submits the bill for the medical treatment provided to the patient’s insurance company in the form of various billing codes.  Some codes pay more than others, for the same basic disease process.  Therefore, “acute blood loss anemia” is better to have documented in the chart when compared to just “anemia” because apparently insurance will reimburse the hospital more for the treatment of “acute blood loss anemia.”  Now this is just an example of a code that comes up many times a day in my field, and there are obviously many other examples out there.

Since what we, as doctors, write in the medical chart is what the billing is based around, it is important to use phrases that are both accurate and complete.  It would seem like a foolish business strategy to provide care for a condition and then not receive full compensation because you wrote “anemia,” when it was really “acute blood loss anemia.” This is not fraud or shady business.  The insurance companies are asking the doctors to be specific and accurate and will look for any way to penalize the hospital financially for not doing so.  Therefore, since it is smart business to bill appropriately, every hospital has a clinical documentation specialist (usually more than just one) who has the sole job of combing through notes and looking for vague language that can be clarified and strengthened to ensure appropriate billing.  If documentation was left up to the individual physician, notes would be two lines long, and the hospital would get paid about $5 from Medicare.

All doctors dread the call from the clinical documentation specialist.  We know it is a necessary thing, but we are busy and simply don’t want to be bothered ten times a day writing addenda to old notes for the sake of billing compliance.  Therefore, as any species does, the doctor adapts to new behaviors that result in fewer calls from the documentation police.  Greater work-related fitness is achieved, and these adaptive “mutations” are passed on to future generations of doctors; it is medical Darwinism.  Soon we begin to think and even talk in medical billing codes instead of actual medical terms.

The 40 year-old lawyer with a drinking problem who develops the shakes the morning after an elective surgery becomes a 40M with alcohol dependence, abnormal liver function tests, thrombocytopenia, acute alcoholic hepatitis, acute alcohol withdrawal, depression, folate deficiency, hypertension (not uncontrolled), and malnutrition (mild).  All of those problems were identified, treated, and now billed for appropriately.

I thank the hospital doctor for the consult and then go to the ER to find the patient.  “Acute blood loss anemia” really tells me nothing about the patient.  Is she sick? Is this really an upper GI bleed, or a GI bleed at all? Did she drop her blood count by a few points (enough to qualify for acute blood loss) or did she lose half of her blood volume? These are all questions that can only be answered by a good history and physical, and cannot be captured in billing code jargon.

I would love to write more on this topic, however I was just called to see a patient with “unspecified viral hepatitis C without mention of hepatic coma,” so I have to run.

Frederick Gandolfo is a gastroenterologist who blogs at Retroflexions.

Prev

Patients can spot the fake: They need the authentic

August 15, 2015 Kevin 2
…
Next

A fetal complication is an extension of a mother

August 16, 2015 Kevin 1
…

Tagged as: Gastroenterology, Hospital-Based Medicine, Hospitalist

Post navigation

< Previous Post
Patients can spot the fake: They need the authentic
Next Post >
A fetal complication is an extension of a mother

More by Frederick Gandolfo, MD

  • White coats should no longer be worn by physicians

    Frederick Gandolfo, MD
  • Before starting your own practice, do these 3 things first

    Frederick Gandolfo, MD
  • Don’t forget this common trigger of cyclic vomiting syndrome

    Frederick Gandolfo, MD

Related Posts

  • Reflections after a medical student’s first code blue

    Danielle Verghese
  • Why do doctors who hate being doctors still practice?

    Kristin Puhl, MD
  • A code, a trauma, and our fragile humanity

    Amy Blake
  • Doctors: It’s time to unionize

    Thomas D. Guastavino, MD
  • Doctors die. But the good ones leave a legacy.

    Jaime B. Gerber, MD
  • A medical student’s first code. Here’s what he learned.

    Timothy S. Kelly

More in Physician

  • Unlearning our habits: a journey from intelligence to wisdom

    Brian Sayers, MD
  • Beyond pizza and pens: National Doctors’ Day should be about saving lives

    James Young, MD
  • Maximizing physician potential: How coaching can aid in conflict resolution, enhance health care leadership and build stronger teams

    Asha Padmanabhan, MD
  • Physicians are a finite resource we need to protect

    Jack Resneck, Jr., MD
  • Tom Brady’s legacy and the importance of personal integrity in end-of-life choices

    Kevin Haselhorst, MD
  • The hidden truths of hospital life: What doctors wish you knew

    Emily Stanford, DO
  • Most Popular

  • Past Week

    • What is driving physicians to the edge of despair?

      Edward T. Creagan, MD | Physician
    • The untold struggles patients face with resident doctors

      Denise Reich | Conditions
    • Beyond pizza and pens: National Doctors’ Day should be about saving lives

      James Young, MD | Physician
    • Physicians are a finite resource we need to protect

      Jack Resneck, Jr., MD | Physician
    • From clocking in to clocking out: the transition to retirement

      Debbie Moore-Black, RN | Conditions
    • Unlearning our habits: a journey from intelligence to wisdom

      Brian Sayers, MD | Physician
  • Past 6 Months

    • The real cause of America’s opioid crisis: Doctors are not to blame

      Richard A. Lawhern, PhD | Meds
    • Nobody wants this job. Should physicians stick around?

      Katie Klingberg, MD | Physician
    • The vital importance of climate change education in medical schools

      Helen Kim, MD | Policy
    • The fight for reproductive health: Why medication abortion matters

      Catherine Hennessey, MD | Physician
    • Resetting the doctor-patient relationship: Navigating the challenges of modern primary care

      Jeffrey H. Millstein, MD | Physician
    • It’s time for C-suite to contract directly with physicians for part-time work

      Aaron Morgenstein, MD & Corinne Sundar Rao, MD | Physician
  • Recent Posts

    • Unlearning our habits: a journey from intelligence to wisdom

      Brian Sayers, MD | Physician
    • Lessons from an orthopedic surgery journey [PODCAST]

      The Podcast by KevinMD | Podcast
    • Beyond pizza and pens: National Doctors’ Day should be about saving lives

      James Young, MD | Physician
    • Maximizing physician potential: How coaching can aid in conflict resolution, enhance health care leadership and build stronger teams

      Asha Padmanabhan, MD | Physician
    • The future of education: AI empowerment, YouTube college credits, and the impact on traditional colleges

      Harvey Castro, MD, MBA | Tech
    • The beauty of a patient’s gratitude

      Dr. Damane Zehra | Conditions

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 7 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

CME Spotlights

From MedPage Today

Latest News

  • Moderna's Steep COVID Vaccine Price: Corporate Greed or Capitalism?
  • House Republican Argues Against FDA Budget Increase
  • Prescriptions for Stimulants Jumped During the Pandemic
  • Federal Judge Strikes Down ACA's Preventive Care Coverage Requirements
  • Pandemic Jump in ED Visits for Firearm Injuries Continued Into 2022

Meeting Coverage

  • VTE Risk in Recurrent Ovarian Cancer Increases With More Lines of Chemotherapy
  • Obesity's Impact on Uterine Cancer Risk Greater in Younger Age Groups
  • Oral Roflumilast Effective in the Treatment of Plaque Psoriasis
  • Phase III Trials 'Hit a Home Run' in Advanced Endometrial Cancer
  • Cannabis Use Common in Post-Surgery Patients on Opioid Tapering
  • Most Popular

  • Past Week

    • What is driving physicians to the edge of despair?

      Edward T. Creagan, MD | Physician
    • The untold struggles patients face with resident doctors

      Denise Reich | Conditions
    • Beyond pizza and pens: National Doctors’ Day should be about saving lives

      James Young, MD | Physician
    • Physicians are a finite resource we need to protect

      Jack Resneck, Jr., MD | Physician
    • From clocking in to clocking out: the transition to retirement

      Debbie Moore-Black, RN | Conditions
    • Unlearning our habits: a journey from intelligence to wisdom

      Brian Sayers, MD | Physician
  • Past 6 Months

    • The real cause of America’s opioid crisis: Doctors are not to blame

      Richard A. Lawhern, PhD | Meds
    • Nobody wants this job. Should physicians stick around?

      Katie Klingberg, MD | Physician
    • The vital importance of climate change education in medical schools

      Helen Kim, MD | Policy
    • The fight for reproductive health: Why medication abortion matters

      Catherine Hennessey, MD | Physician
    • Resetting the doctor-patient relationship: Navigating the challenges of modern primary care

      Jeffrey H. Millstein, MD | Physician
    • It’s time for C-suite to contract directly with physicians for part-time work

      Aaron Morgenstein, MD & Corinne Sundar Rao, MD | Physician
  • Recent Posts

    • Unlearning our habits: a journey from intelligence to wisdom

      Brian Sayers, MD | Physician
    • Lessons from an orthopedic surgery journey [PODCAST]

      The Podcast by KevinMD | Podcast
    • Beyond pizza and pens: National Doctors’ Day should be about saving lives

      James Young, MD | Physician
    • Maximizing physician potential: How coaching can aid in conflict resolution, enhance health care leadership and build stronger teams

      Asha Padmanabhan, MD | Physician
    • The future of education: AI empowerment, YouTube college credits, and the impact on traditional colleges

      Harvey Castro, MD, MBA | Tech
    • The beauty of a patient’s gratitude

      Dr. Damane Zehra | Conditions

MedPage Today Professional

An Everyday Health Property Medpage Today iMedicalApps
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Doctors now diagnose in code. ICD code, that is.
7 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...