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

  1. https://www.aapc.com/blog/50072-burnout-the-struggle-is-real/ 
  2. https://www.ama-assn.org/practice-management/physician-health/pandemic-pushes-us-doctor-burnout-all-time-high-63
  3. https://www.advisory.com/daily-briefing/2023/01/31/physician-burnout
  4. https://bit.ly/47FKgZr  

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.
  1. https://www.ama-assn.org/about/leadership/addressing-another-health-care-shortage-medical-coders
  2. https://aquitysolutions.com/blogs/how-to-solve-coder-overtime-burnout/ 
  3. https://www.aafp.org/about/policies/all/family-physician-burnout.html 
  4. https://www.choosingtherapy.com/physician-burnout/ 

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.

  1. https://bit.ly/3SHT8JC

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 coders@calmwatersai.com

 

Download PDF

Michelle Sergei-Casiano
Michelle Sergei-Casiano
Michelle Sergei-Casiano
CPC, CFPC, CEMC Senior Manager, Regulatory and Coding Compliance coders@calmwatersai.com

 

More Coffee & Coding

What, precisely, is a “self-limited” condition?

What, precisely, is a “self-limited” condition? May 6, 2024 This issue is a continuing source of uncertainty for coders and providers alike, especially since we all analyze and apply information differently in medical decision making (MDM). So, how can we bring...

More E/M Coding Questions (and Answers!)

More E/M Coding Questions (and Answers!) April 29, 2024 This week, we pick up where we left off with the last issue of Coffee & Coding, when we addressed questions about how tests and lab work can count toward complexity of data in medical decision-making (MDM).1...

When Can the Amount and Complexity of Data Apply to Lab Tests?

When Can the Amount and Complexity of Data Apply to Lab Tests? April 22, 2024 It’s a great question—and one that generates discussions in almost every medical office. In this issue (and next week’s, too), we’ll examine some scenarios that will help you clarify the...

More Pro Tips & Tricks

More Pro Tips & Tricks April 15, 2024 Back by popular demand: We received such a positive response to our “tips and tricks” edition of Coffee & Coding that we’ve decided to make it a recurring feature each quarter. So, we invite you to grab a fresh cup of...

The Problem with Independent Historians

The Problem with Independent Historians April 8, 2024 In most cases, we know who independent historians are: mothers, fathers, guardians, grandparents, or adult children. But we still see many instances when the term is incorrectly applied in the documentation—mostly,...

Making Complexity of Problems a Little Less Complex

Making Complexity of Problems a Little Less Complex April 1, 2024 We see a lot of questions (and confusion) over what constitutes an “acute illness with systemic symptoms.” In fact, according to the American Academy of Pediatrics, “Of the three elements that make up...

Making the Right Choice Between Level 3 and Level 4: Part Two

Making the Right Choice Between Level 3 and Level 4: Part Two March 25, 2024 In last week’s Coffee & Coding, we provided a refresher on key points to remember about coding appropriately for Level 3. This week let’s do the same for Level 4. Level 4 can be a little...

Level 3 or Level 4: Getting It Right

Level 3 or Level 4: Getting It Right March 18, 2024 Guidelines notwithstanding, deciding whether to apply Level 3 or Level 4 to a patient encounter isn’t always easy. In fact, we see a lot of inconsistency and confusion on this point. While many clinicians accurately...

Ending Confusion over Modifier 25

Ending Confusion over Modifier 25 March 11, 2024 It’s a big week here in Boston (my hometown). Sunday, of course, is St. Patrick’s Day. Here in Boston, we also remember March 17 as Evacuation Day—marking the anniversary of the British army leaving the city in 1776....

MDM Level 5: A Quick Refresher on a Complex Subject

MDM Level 5: A Quick Refresher on a Complex Subject March 4, 2024 We continue to see that, across all medical specialties, physicians are still nervous about billing for Level 5 office visits. I consistently find that many (if not most) providers code for Level 4 even...

HIPAA Compliance: Make sure you know ALL the rules

HIPAA Compliance: Make sure you know ALL the rules February 26, 2024 The Health Insurance Portability and Accountability Act (HIPAA) of 1996 is a federal law restricting access to individuals' private medical information. That much, I’m sure, our readers already knew....

Making sense of the new coding-by-time rules for 2024

Making sense of the new coding-by-time rules for 2024 February 19, 2024 We all know that the new year brings changes (some years, more than others). As it turns out, no sooner had we gotten clinicians on track with how much time belongs to the E/M CPT code set than...

How do you code a broken heart?

How do you code a broken heart? Plus: We answer your questions about toxicity monitoring. February 12, 2024 First things first: While remembering to apply the proper codes and include sufficient documentation, providers and coders must not lose sight of one essential...

Documentation Tips and Tricks: How to Avoid Common Mistakes

Documentation Tips and Tricks: How to Avoid Common Mistakes February 5, 2024 Every day we see coding mistakes that affect the accuracy of E/M coding levels. Some of them can be costly. So, in this issue of Coffee & Coding, we’ll look more closely at some of these...

Toxic diagnosis coding: What you may be missing

Toxic diagnosis coding: What you may be missing January 29, 2024 Three quick questions: When did you last look in that little section towards the back of your ICD-10 coding book called the Drug Table? How often have you coded an adverse reaction to a bug bite as...

Subscribe to Our Weekly Coffee & Coding Newsletter