Giving Thanks—and Not Burning Out

November 20, 2023

As you look forward to a long, relaxing weekend of family, food, and fun (and maybe some football, too), we’ll address an issue that increasingly affects both providers and coders—and serve up for Thanksgiving some codes to document types of encounters you might come across this holiday.

Confronting the B-Word

A week, when we all look forward to being with family, relaxing, and de-stressing, might be a good time to address an issue—burnout—that increasingly affects medical professionals. There’s even a code now for this phenomenon: Z73.0.1

The AMA describes physician burnout as an “epidemic.” According to their surveys, burnout rates spiked to an all-time high of 63% in 2021.2 A Medscape study published in 2023 showed that, even among physician specialties with the lowest burnout rates, levels were alarmingly high: 43% for cardiologists, 45% for orthopedists, and 47% for urologists.3

The causes are multiple and often interconnected. They range from long hours to reimbursement issues, frustrations with referral networks, medical-legal issues, administrative burdens, shortage of healthcare workers, and difficult patients. Physicians themselves identify the burden of documentation (a problem that Calm Waters AI helps address) as the number one reason they experience burnout. Studies bear out that perception. According to one, physicians who spent more than six hours per week on after-hours charting were twice as likely to record higher burnout scores than those who spent less than five hours a week on this task after hours.4


Less publicized but no less serious is the problem of coder burnout. It’s real—and it’s a key reason why there’s a 30% shortage of qualified coders today.5 Here, too, heavy workload is a major contributor. A LinkedIn survey found that over half of medical coders work overtime every week; 37% report working more than one hour of overtime each day, and 15% average more than two hours per day.6

Practical Steps for Coders and Physicians

Obviously, we can’t remediate all the factors contributing to clinician and coder burnout. In this space, I want to address a few simple things coders and physicians can do in our work to reduce the effects of burnout.

    1. Remember that stressors are contagious. If a physician has just completed a visit with a difficult patient, or a coder is dealing with a heavy workload, the resulting stress can manifest itself in various ways—from tone of voice and loss of patience to mannerisms that make others feel stressed, too, or even feel like they’ve done something wrong.7 Being conscious of these behaviors and working to limit them can contribute more than you might think to reducing burnout.
    2. Be mindful of each other’s burdens—and avoid adding to them. Working with anxious patients who may come off as demanding or combative, physicians must navigate “a complex emotional landscape while providing quality healthcare” and handling administrative tasks. Repetitive tasks, such as those coders perform, require a lot of energy to maintain focus, which can contribute to fatigue and burnout.8 Simply being mindful of these stressors and consciously working to make each other’s work a little easier can give everyone a much-needed lift.
    3. Reduce isolation. The factors that contribute to burnout are exacerbated when people work in silos, making them feel more isolated. As much as possible, create more opportunities for direct interaction with each other, from casual conversations to more structured time together.
    4. Show appreciation and respect every day. As essential as their work is, physicians often report feeling under-appreciated, and it’s a factor that leads to burnout. Coders perform a vital function, but they, too, frequently feel their contributions aren’t valued. Ordinary affirmations—sometimes as simple as saying “thank you,” or recognizing in the presence of others the value of someone’s efforts—can go a long way toward helping colleagues feel less stressed and more energized about their job.

Especially this week, let’s remember to be thankful for our physician and coder colleagues who work together to make their organizations and each other more successful.

Now for a few timely codes:

W61.43XA – Pecked by a Turkey / W71.43XA
It’s more common than you might imagine, especially during turkey mating season in the spring. And in case you were wondering, yes, there is a separate code to use (W61.33XA) if your patient is pecked by a chicken. So, obviously, there is yet another code to apply in case of being struck by a duck (W61.42XA).

W61.42XA – Struck by a Turkey
Did you know that commercial turkeys generally can’t mate naturally because they’ve been bred to have large, muscular breasts to yield more white meat? These birds can pack a wallop. Here in the Boston area, where I live, a letter carrier earlier this year was bowled over by two aggressive wild turkeys, leaving him with a broken hip that required a replacement.9

W29.1XXA Contact with Electric Knife
Be extra careful carving that turkey. Of course, carving accidents can also happen with a regular knife. The code for those cases is W26.0XXA.

W52 – Crushed, Pushed, or Stepped on by a Crowd or Human Stampede
We might call this the Black Friday Code. Don’t laugh: According to one report, between 2006 and 2018, more than 100 people were injured by surging crowds of Black Friday shoppers.


E70.5 – Disorders of Tryptophan Metabolism

R63.2 – Polyphagia Excessive Eating Hyperalimentation on NOS
Overstuffed from Thanksgiving dinner? You might need to apply one of these codes.

W21.01XA – Struck by Football, Initial Encounter
What, you didn’t think there would be a code for that?


Happy Thanksgiving from our Calm Waters AI and Coffee & Coding family to yours!

Got a question about E/M coding? We’d love to hear from you.

Submit your questions by emailing us at


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Michelle Sergei-Casiano
Michelle Sergei-Casiano
Michelle Sergei-Casiano
CPC, CFPC, CEMC Senior Manager, Regulatory and Coding Compliance


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