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

When medical coders blame physicians

Robert Donnell, MD
Physician
March 16, 2018
70 Shares
Share
Tweet
Share

An interesting paper in CMAJ Open reports on a series of interviews with coders concerning their perceptions of their interactions with doctors. The study was done in Canada, but it rings true to what we experience in the U.S. The fundamental objective of coding is the same: to translate information about the patient’s story into a series of numeric ICD-10 codes for various administrative purposes. Several themes emerged from these interviews. Form the abstract of the paper:

Results:

Five themes emerged regarding physician-related barriers in coding of high-quality administrative data: 1) coders are limited in their ability to add to, modify or interpret physician documentation, which supersedes all other chart documentation, 2) physician documentation is incomplete and nonspecific, 3) chart information tends to be replete with errors and discrepancies, 4) physicians and coders use different terminology to describe clinical diagnoses and 5) there is a communication divide between coders and physicians, such that questions and issues regarding physician documentation cannot be reconciled.

Interpretation:

Physicians play a major role in influencing the quality of administrative data. There is a need for physicians to advocate for culture change in physicians’ attitudes toward coders and chart documentation, in recognition of the importance of accurate chart information.

So the bottom line is that there is a significant divide between physicians and coders and it’s all the physicians’ fault.

But let’s unpack this. The coders perceive that physician documentation is “replete with errors and discrepancies.” We are repeatedly admonished by coders to “document correctly.” But what does that really mean? In the coding world, it means using terms that align with administrative language. A nuanced account by the physician detailing all the complexities and uncertainties in the patient’s diagnosis and treatment is unlikely to pass muster.

The coders also complained that doctors are often not specific enough. What they fail to realize is that often we don’t have enough information to make a specific diagnosis in which case we must simply state the patient’s problem at the level of resolution we have, and not attempt to go beyond that. To do so, to be too specific too early, increases the risk of real diagnostic error. It’s a fundamental principle that Lawrence Weed, the originator of the problem-oriented medical record, taught us decades ago.

The authors of the cited paper got one thing right though. Coders and doctors are operating with two separate languages: clinical language and administrative language. Clinical language tells the patient’s story and acknowledges all the uncertainty in the clinician’s reasoning process. You lose a large piece of that when you try to reduce that story to a list of codes. Doctors need to stand up for meaningful clinical documentation. Tension invariably results. Don’t expect medical record chaos to end anytime soon. Remember above all: words are supposed to mean things.

Robert Donnell is a hospitalist who blogs at Notes from Dr. RW.

Image credit: Shutterstock.com

Prev

When doing "nothing" really matters

March 16, 2018 Kevin 4
…
Next

MKSAP: 38-year-old man is evaluated during a periodic health maintenance visit

March 17, 2018 Kevin 0
…

Tagged as: Practice Management, Primary Care

Post navigation

< Previous Post
When doing "nothing" really matters
Next Post >
MKSAP: 38-year-old man is evaluated during a periodic health maintenance visit

More by Robert Donnell, MD

  • What to do when a patient wants to leave the hospital against medical advice

    Robert Donnell, MD
  • a desk with keyboard and ipad with the kevinmd logo

    Where has evidence based medicine taken us in 20 years?

    Robert Donnell, MD
  • a desk with keyboard and ipad with the kevinmd logo

    Judging a guideline just by financial interest is intellectually lazy

    Robert Donnell, MD

Related Posts

  • Physicians and medical students: Unlearn helplessness

    Jamie Katuna
  • Digital advances in the medical aid in dying movement

    Jennifer Lynn
  • Medical students and physicians are forever looking to milestones

    Bruce Campbell, MD
  • Are patients using social media to attack physicians?

    David R. Stukus, MD
  • The risk physicians take when going on social media

    Anonymous
  • Beware of pseudoscience: The desperate need for physicians on social media

    Valerie A. Jones, MD

More in Physician

  • The essence of health narratives, including poetry

    Arthur Lazarus, MD, MBA
  • Discover the power of patience

    Diane W. Shannon, MD, MPH
  • Doctors rediscover joy in practicing medicine, on their own terms

    Kim Downey, PT
  • Physician return-to-work policies

    Deepak Gupta, MD
  • How my patients’ Zoom backgrounds made me a better doctor

    Joseph Barrera, MD
  • Understanding reproductive rights: complex considerations

    Anonymous
  • Most Popular

  • Past Week

    • Challenging the diagnosis: dehydration or bias?

      Sydney Lou Bonnick, MD | Physician
    • A teenager’s perspective: the pressing need for mental health days in schools

      Ruhi Saldanha | Conditions
    • Understanding reproductive rights: complex considerations

      Anonymous | Physician
    • COVID-19 unleashed an ongoing crisis of delirium in hospitals

      Christina Reppas-Rindlisbacher, MD, Nathan Stall, MD, and Paula Rochon, MD | Conditions
    • Air quality alert: Reducing our carbon footprint in health care

      Shreya Aggarwal, MD | Conditions
    • America’s young men are facing a mental health crisis. Can we help them before it’s too late?

      Henna Hundal and Karan Patel | Conditions
  • Past 6 Months

    • Medical gaslighting: a growing challenge in today’s medical landscape

      Tami Burdick | Conditions
    • I want to be a doctor who can provide care for women: What states must I rule out for my medical education?

      Nandini Erodula | Education
    • Balancing opioid medication in chronic pain

      L. Joseph Parker, MD | Conditions
    • Unveiling excessive medical billing and greed

      Amol Saxena, DPM, MPH | Policy
    • The erosion of patient care

      Laura de la Torre, MD | Physician
    • I’m a doctor, and I almost died during childbirth

      Bayo Curry-Winchell, MD | Physician
  • Recent Posts

    • America’s young men are facing a mental health crisis. Can we help them before it’s too late?

      Henna Hundal and Karan Patel | Conditions
    • When physicians are disrespected [PODCAST]

      The Podcast by KevinMD | Podcast
    • Addressing dual diagnosis needs in addiction treatment

      Susan Hertz Berrick, EdD | Conditions
    • The essence of health narratives, including poetry

      Arthur Lazarus, MD, MBA | Physician
    • Discover the power of patience

      Diane W. Shannon, MD, MPH | Physician
    • Doctors rediscover joy in practicing medicine, on their own terms

      Kim Downey, PT | Physician

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 6 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

  • Novavax's Updated COVID Shot Authorized by FDA
  • SBRT Noninferior to Conventional RT for Intermediate-Risk Prostate Cancer
  • Mixed Bag for Early Metformin in Gestational Diabetes
  • FDA Advisors to Consider DFMO Maintenance for High-Risk Neuroblastoma in Kids
  • Adding Tirzepatide to Basal Insulin Cuts HbA1c in Poorly Controlled T2D

Meeting Coverage

  • SBRT Noninferior to Conventional RT for Intermediate-Risk Prostate Cancer
  • Mixed Bag for Early Metformin in Gestational Diabetes
  • Adding Tirzepatide to Basal Insulin Cuts HbA1c in Poorly Controlled T2D
  • Low Relapse Rates With Twice-Yearly Schizophrenia Treatment
  • Menopause Can Negatively Affect Women's Careers
  • Most Popular

  • Past Week

    • Challenging the diagnosis: dehydration or bias?

      Sydney Lou Bonnick, MD | Physician
    • A teenager’s perspective: the pressing need for mental health days in schools

      Ruhi Saldanha | Conditions
    • Understanding reproductive rights: complex considerations

      Anonymous | Physician
    • COVID-19 unleashed an ongoing crisis of delirium in hospitals

      Christina Reppas-Rindlisbacher, MD, Nathan Stall, MD, and Paula Rochon, MD | Conditions
    • Air quality alert: Reducing our carbon footprint in health care

      Shreya Aggarwal, MD | Conditions
    • America’s young men are facing a mental health crisis. Can we help them before it’s too late?

      Henna Hundal and Karan Patel | Conditions
  • Past 6 Months

    • Medical gaslighting: a growing challenge in today’s medical landscape

      Tami Burdick | Conditions
    • I want to be a doctor who can provide care for women: What states must I rule out for my medical education?

      Nandini Erodula | Education
    • Balancing opioid medication in chronic pain

      L. Joseph Parker, MD | Conditions
    • Unveiling excessive medical billing and greed

      Amol Saxena, DPM, MPH | Policy
    • The erosion of patient care

      Laura de la Torre, MD | Physician
    • I’m a doctor, and I almost died during childbirth

      Bayo Curry-Winchell, MD | Physician
  • Recent Posts

    • America’s young men are facing a mental health crisis. Can we help them before it’s too late?

      Henna Hundal and Karan Patel | Conditions
    • When physicians are disrespected [PODCAST]

      The Podcast by KevinMD | Podcast
    • Addressing dual diagnosis needs in addiction treatment

      Susan Hertz Berrick, EdD | Conditions
    • The essence of health narratives, including poetry

      Arthur Lazarus, MD, MBA | Physician
    • Discover the power of patience

      Diane W. Shannon, MD, MPH | Physician
    • Doctors rediscover joy in practicing medicine, on their own terms

      Kim Downey, PT | Physician

MedPage Today Professional

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

When medical coders blame physicians
6 comments

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

Loading Comments...