99238

No matter how down I am on the day, the week, the world, and healthcare in general - at the end of the day, when have I finished reading and coding a hospital stay for a patient, I am always happy to see these five numbers:

99238 - discharge services less than 30 minutes

Rub some dirt in it and get back in the game, folks. It's all we can do.

Soft Shell

I must be going soft.

I am very big on personal responsibility and accountability. That is why I get bristly when I come across patients who, through poor lifestyle choices and non-compliance, jump on the dole by way of taxpayer funded healthcare.

Lately though, I have started to be less angry and more full of disgruntled pity.

Should I be continually pissed off to see my tax dollars pay for people who don't care enough about his or her own health to be compliant, lose weight, stop smoking, drinking, or consuming drugs?

Or should I be filled with unbridled pity that these people won't  live out the decade? 

Where for art thou, Turtle?

Sorry for the extended absence, folks.

ICD-10 prep is kicking my ass. And I still have mandatory 'coder on call' shifts yet to arrive.

T-minus 27 days - and warning - if you have an appointment scheduled for October 1 please bring your patience and be extra nice to your provider!!

Paging Dr. Haiku

Seen in a chart today under HPI -

in today for pain
mobic not working that good
knee is still hurting

Written just as you see it above.

I decided to read it out loud in a dramatic Captain Kirk voice and got a standing ovation by the coder next to me.

A good day.

Awkward

My son, upon opening and reading a graduation card from his Gran in FRONT of his Gran, said out loud:

"Well. That got deep fast."

Yep, that's my boy. 

XXX

In the medical field, there lives a myriad of acceptable abbreviations. Everyone in the medical field understands what these mean. It's like back in the day with shorthand. If you know the language, you can read it. If you don't, you can't. Simple.

So, take the use of X. The letter X is commonly used by providers to finish a word they simply are too overwhelmed to finish off.

For example:

Fx - fracture
Tx - treatment
Rx - prescription
Sx - symptoms
Dx - diagnosis
Ddx - differential diagnosis

So pretty clear cut, right?

No.

Today, in a chart, a provider stated : Pt (another shortcut) here for CPX.

I had to pause for a moment. Although I've been in the medical field for quite some time, this one was new. So I kept reading. Then I got it. Patient here for a routine physical.

Now.....normally, a routine physical is abbreviated to CPE. Comprehensive physical exam. So I had to ask, "Turtle, isn't E easier to tap on the keyboard than X?"

There was no answer from the universe around me. Why would the provider choose a more difficult letter to finish off the completion of an already abbreviated procedure?

The use of X has gotten way out of hand! Stop it! Just....no.

Stop it or I will hunt you down and cause you APX (acute physical pain). Yeah, I made that up!

I fully expect, if this is allowed to continue, to read something like:

Px here for fx fu. Tx plan by Dr. X and rx called in. Rdx following. Sx include pain at site, ddx possible sepsis. Pls sx pt for CPX in six months.

What? Ugh.

I don't remember getting a decoder ring when I was hired.

Triple Crown

Years ago, after a short hospital stay, my father opined, "If you stay in the hospital long enough, they will kill you." Never thought much more about it until I entered medical coding and boy, was he right.

It's like the Run for the Roses.

And.....they're off!

And it's Afib early out of the gates with a strong start, followed closely by Anti Coag.

Afib and Anti Coag holding strong in the lead going into day 1.

As we round day 1, it's Afib and Anti Coag holding the lead spots, CDiff is bringing up the rear of the top three and eyeing the track ahead closely. Trochanteric FX, who had a rough start, a distant fourth, followed by History of Falls who is trying to assert its place in the lineup.

Coming into day 2, it's Afib and Anti Coag holding strong, CDiff a few strides behind in third, Trochanteric FX lagging terribly in fourth. History of Falls is history.

And we round day 2 with Afib still in the lead, Anti Coag in second, and CDiff in third. And Trochanteric FX goes down! What a stumble! And Trochanteric FX is out of the race! Devastating!

And into day 3 we go......And CDiff makes a break! Closing the gap on Afib and Anti Coag!! What a remarkable turn of events! Who would have known CDiff had the strength! CDiff overtakes Anti Coag from the inside and sets its sight on Afib as we round out day 3.

And coming into day 4 - , CDiff overtakes Afib for the lead!! Remarkable endurance! Did you see how CDiff squeezed through like that! And we have CDiff in the lead, folks, widening the gap for first over Afib and Anti Coag.

And we round out day 4 with CDiff in the lead, Afib a memory, Anti Coag an after-thought in third. Trochanteric is being led off the track. Godspeed. A fine showing.

And into day 5 it's.....LOOK AT THAT! It's MRSA! MRSA, who barely made it out of the gate, MRSA, who was discounted by all as a remote chance is now galloping full speed - MRSA, who had been rounding the days quietly as if on a summer stroll, now overtaking Anti Coag, sights set on Afib, while CDiff struggles to maintain the lead!

And now, rounding day 5 it's still CDiff in the lead. MRSA looks mighty strong.....overtaking Afib and leaving Anti Coag in the dust! Hard to believe those two started so strong. Now all eyes are on CDiff and MRSA.....what a race! Can CDiff prevail? Or will the silent sleeper MRSA finally be recognized as a contender in this race?

All eyes on CDiff and MRSA.....CDiff struggling to hold the lead, MRSA ....and MRSA from the outside! It's MRSA! Overtaking CDiff for the lead! Approaching the finish line it's MRSA! It's MRSA - winning out over very strong contenders Afib, Anti Coag, and CDiff.....

And it's MRSA, for the win.

Yep.