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
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

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

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

  • When the white coats become gatekeepers: How a quiet cartel strangles America’s health

    Anonymous
  • The man in seat 11A survived, but why don’t our patients?

    Dr. Vivek Podder
  • When did we start treating our lives like trauma?

    Maureen Gibbons, MD
  • Medicalizing burnout misses the real problem

    Jessie Mahoney, MD
  • Why some doctors age gracefully—and others grow bitter

    Patrick Hudson, MD
  • The hidden incentives driving frivolous malpractice lawsuits

    Howard Smith, MD
  • Most Popular

  • Past Week

    • 2 hours to decide my future: How the SOAP residency match traps future doctors

      Nicolette V. S. Sewall, MD, MPH | Education
    • Why removing fluoride from water is a public health disaster

      Steven J. Katz, DDS | Conditions
    • When did we start treating our lives like trauma?

      Maureen Gibbons, MD | Physician
    • In a fractured world, Brian Wilson’s message still heals

      Arthur Lazarus, MD, MBA | Physician
    • When your dream job becomes a nightmare [PODCAST]

      The Podcast by KevinMD | Podcast
    • How doctors took back control from hospital executives

      Gene Uzawa Dorio, MD | Physician
  • Past 6 Months

    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • The silent toll of ICE raids on U.S. patient care

      Carlin Lockwood | Policy
    • Why shared decision-making in medicine often fails

      M. Bennet Broner, PhD | Conditions
    • My journey from misdiagnosis to living fully with APBD

      Jeff Cooper | Conditions
    • Why we fear being forgotten more than death itself

      Patrick Hudson, MD | Physician
  • Recent Posts

    • When your dream job becomes a nightmare [PODCAST]

      The Podcast by KevinMD | Podcast
    • Finding healing in narrative medicine: When words replace silence

      Michele Luckenbaugh | Conditions
    • Why coaching is not a substitute for psychotherapy

      Maire Daugharty, MD | Conditions
    • When the white coats become gatekeepers: How a quiet cartel strangles America’s health

      Anonymous | Physician
    • Why doctors stay silent about preventable harm

      Jenny Shields, PhD | Conditions
    • Why interoperability is key to achieving the quintuple aim in health care

      Steven Lane, MD | Tech

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

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

  • Most Popular

  • Past Week

    • 2 hours to decide my future: How the SOAP residency match traps future doctors

      Nicolette V. S. Sewall, MD, MPH | Education
    • Why removing fluoride from water is a public health disaster

      Steven J. Katz, DDS | Conditions
    • When did we start treating our lives like trauma?

      Maureen Gibbons, MD | Physician
    • In a fractured world, Brian Wilson’s message still heals

      Arthur Lazarus, MD, MBA | Physician
    • When your dream job becomes a nightmare [PODCAST]

      The Podcast by KevinMD | Podcast
    • How doctors took back control from hospital executives

      Gene Uzawa Dorio, MD | Physician
  • Past 6 Months

    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • The silent toll of ICE raids on U.S. patient care

      Carlin Lockwood | Policy
    • Why shared decision-making in medicine often fails

      M. Bennet Broner, PhD | Conditions
    • My journey from misdiagnosis to living fully with APBD

      Jeff Cooper | Conditions
    • Why we fear being forgotten more than death itself

      Patrick Hudson, MD | Physician
  • Recent Posts

    • When your dream job becomes a nightmare [PODCAST]

      The Podcast by KevinMD | Podcast
    • Finding healing in narrative medicine: When words replace silence

      Michele Luckenbaugh | Conditions
    • Why coaching is not a substitute for psychotherapy

      Maire Daugharty, MD | Conditions
    • When the white coats become gatekeepers: How a quiet cartel strangles America’s health

      Anonymous | Physician
    • Why doctors stay silent about preventable harm

      Jenny Shields, PhD | Conditions
    • Why interoperability is key to achieving the quintuple aim in health care

      Steven Lane, MD | Tech

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...