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Patient Admitted with Acute on Subacute on Subchronic on Chronic Congestive Systolic Heart Failure

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CHARLESTON, SC – Sure to both please medical coders and confuse medical staff, hospitalist Mitchell Essex has listed as the first problem on his patient’s problem list “acute on subacute on subchronic on chronic congestive systolic heart failure.”

“Leave it to Essex,” said a fellow hospitalist at Charleston Medical Center, who glossed over Essex’s H&P (history-and-physical examination note). “He’s a documentation pro. He knows how to bring in those RVUs.”

According to Essex’s note, which we looked at with Essex’s permission, the patient has a known history of chronic systolic congestive heart failure (CHF) with an EF 25%, also known as heart failure reduced ejection fraction. However, the patient started noticing a gradual worsening of shortness of breath and leg edema over the past 3 months, which then gradually worsened even more over the past 90 days, which then really got really bad over the past 24 hours.”

“It’s a classic presentation of acute on subacute on subchronic on chronic CHF if you ask me,” replied a very matter-of-fact Essex. “Seriously, classic presentation. I just document it the way it is, that’s all.”

Behind closed doors in a room filled with incense, medical coders have sacrificed another virgin copy of ICD-10 in front of a framed picture of Mitchell Essex, whom they believe is a real-life documentation deity.

“If only every health care provider can document with such precision and clarity as Him,” said medical coder Avery Meloy, taking a pause between his prayers to Lord Essex. “He is the only doctor in modern medicine never to be queried by us.”

Rumors are circulating that Essex is about to admit a patient with hyperacute on acute on subacute on subchronic on chronic on hyperchronic hypoxemic & hypercapnic respiratory failure due to COPD.

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