paddles for defibrillation

Hospitalist Administering CPR Interrupted With STAT Coding Query

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paddles for defibrillationBOCA RATON, FLORIDA — Area hospitalist Dr. Sri-Sheshadariprativadibayankaram was running a code on a pulseless patient when he received an emergent coding query on his cell phone. Gomerblog has obtained an official transcript of the dialog from the billing compliance department, which records all of its calls for quality assurance.

DOCTOR: “Hello?”

CODER: “Hi Dr. Sri-Sheshadariprativadibayankaram, I need to talk to you right now.”

DOCTOR: “Well I’m in the middle of giving my patient CPR. Can’t this wait?”

CODER: “No, this is about coding our patient bill based on your documentation.”

DOCTOR: “What?”

CODER: “We can’t submit our charges for the patient you’re with right now until you respond to my online coding query. WHAT PART OF THIS DON’T YOU UNDERSTAND?!”

DOCTOR: “When did you send me the online coding query?”

CODER: “About 30 seconds ago. Why haven’t you logged on yet?!”

DOCTOR: “Because I’m in the middle of trying to save somebody’s life ri–”

CODER: “We are running out of time. I can do this verbally now. I was reading your progress note on the patient’s chart from this morning and you mentioned that he has a ‘hangnail’ requiring dilaudid for pain control in the Assessment & Plan section.”

DOCTOR: “Yes, he has a hangnail — WHEN WAS OUR LAST DOSE OF EPI?!!”

CODER: “Listen, I need you to focus on this now. I need more ICD-10 descriptors regarding the hangnail to maximize the charges. Was it acute, chronic, or acute-on-chronic?”

DOCTOR: “The hangnail?!”


DOCTOR: “Acute.”

CODER: “What stage was the hangnail?”

DOCTOR: “There’s hangnail staging?”

CODER: “Forget it, I’ll just mark it as ‘unstageable’ for now.”

DOCTOR: “Was the hangnail malignant?”

CODER: “Malignant? I mean, I didn’t send it for biopsy.”

DOCTOR: “This is CRITICAL to assess the patient’s ROM [Risk Of Mortality].”

CODER: “Was the hangnail present on admission?”


CODER: “Would you characterize the diagnosis as ‘hangnail failure’ or ‘hangnail insufficiency’ — we would strongly prefer the first choice.”

DOCTOR: “Fine, hangnail failure.”

CODER: “Does the patient have systolic or diastolic heart failure?”

DOCTOR: “Systolic. What does this have to do with his hangn–”

CODER: “Does the patient have severe protein calorie malnutrition?”

DOCTOR: “Yes.”

CODER: “Sepsis?”

DOCTOR: “Yes.”

CODER: “Present on admission?”

DOCTOR: “Sure.”

CODER: “Was this a ‘critical care hangnail encounter with dilaudid and lozenge dispensation’ today?”

DOCTOR: “Yeah, whatever.”

CODER: “So I’m going to submit this as ‘acute critical unstageable possibly malignant hangnail failure present on admission, complicated by systolic heart failure, severe protein calorie malnutrition & sepsis present on admission, with dilaudid and lozenge dispensation NOS’ now.

DOCTOR: “WHAT THE <expletive> is this <expletive> <expletive>?!!!” [call ends]


As of press time, Gomerblog has learned that the hospital, in order to maintain profit growth trajectories, has once again cut the pay for Dr. Sri-Sheshadariprativadibayankaram. And also the nurses. The hospital cut their pay too.

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