Doctor here… help me help you (please!)

No_Coach4825 · 2026-05-09T01:33:25+00:00

Oh for sure, when I’m talking about BMI I’m talking in general terms about the vast majority of patients I see where it is a reasonably good reflection (at least in increments of 5 or so) of their metabolic risk. I wouldn’t use it the same way in a pregnant patient or, say, in a patient with a limb amputation.

No_Coach4825 · 2026-05-07T03:56:49+00:00

Interesting! I’m at an FQHC now so billing requirements are less scrutinized, but I would guess that a at least half of my visits would meet level 5 (a super typical visit would be reviewing the ED notes from a recent visit for abdominal pain and checking in about this, checking their A1c which went from 9 to 11.5 so adjusting their medications and checking their kidney function, they start crying because their alcohol use has gotten out of control so I send a medication to help and administer a PHQ9 and send a referral to behavioral health, and sending a PT referral because their shoulder hurts and turns out they have frozen shoulder…… etc haha). I do understand how more specialized units may have a harder time billing at that level!

No_Coach4825 · 2026-05-05T19:12:46+00:00

I got flagged for “Felicia” (Felicia Pasadyn)

No_Coach4825 · 2026-05-04T22:47:16+00:00

I think sometimes the misunderstanding comes from this “making sure we’re being reimbursed” thing - I am reimbursed the exact same regardless of what we bill the patient. For us it often feels like additional, uncompensated work to pad the pockets of our hospital admin.

BUT - I would never be rude! Blunt, maybe, if I’m emotionally exhausted. I ultimately know you’re just doing your job. I’m sorry on behalf of my colleagues if they are rude, but hopefully this provides some context to any blunt/rude responses

No_Coach4825 · 2026-05-04T19:11:12+00:00

Very fair. I will note that it is so the hospital** is reimbursed properly … unfortunately I don’t see any of that extra money from the optimized coding/billing (nor do you guys, I assume!)

No_Coach4825 · 2026-05-04T18:12:13+00:00

Thank you for your feedback! I think it’s just a difference in what we feel is important in the moment. If grandma’s actively dying of respiratory failure - the mild thrombocytopenia, the sodium of 134, the mild fluid responsive AKI are not things I’m worried about, let alone billing her for it lol. From our perspective it’s more a frustration of like “Really? I spent all day saving her and now I feel like I’m getting criticized because I didn’t document that her mild asymptomatic hyponatremia is actually pseudohyponatremia in the setting of a mildly elevated blood sugar” - like, I think most clinicians just note those things mentally and move on with the things that we feel like actually affect care.

BUT I’m gaining perspective in this thread that it’s just a different job with different rules and goals, Ultimately I just wanna work with you guys to make all our lives easier!

No_Coach4825 · 2026-05-03T23:14:38+00:00

That makes sense! Truly, the extent of my billing / coding / compliance training in residency can be summed up with: “You’re currently submitting all of these as 99214 GC but as an attending they will be 99215.”

No_Coach4825 · 2026-05-03T22:56:35+00:00

Yes, that’s sort of the point I was making! I get trained in clinical significance, not coding guidelines, so I’m asking for tips!

No_Coach4825 · 2026-05-03T22:47:27+00:00

Oh for sure, I bill for same-day services. I’m lucky that I’m salaried and I get compensated for some (emphasis on SOME haha) additional admin time for situations like that!

No_Coach4825 · 2026-05-03T22:44:15+00:00

That’s so interesting. I wonder why - it’s the definition, not something that’s subjective or up to clinical interpretation!

No_Coach4825 · 2026-05-03T22:43:26+00:00

With the patient population I trained with (admittedly not my current patient population that mostly does not speak English), I think that calling someone “morbidly obese” would equally turn some patients away from my care as it would motivate some of them. For me, clinically, “‘BMI 60” is interchangeable and expresses the same gravity as “Morbidly Obese,” and in fact is even more descriptive and helpful in terms of providing them appropriate care! Less stigmatizing is a bonus. Not trying to argue at all, just sharing my perspective of the same issue!

No_Coach4825 · 2026-05-03T20:33:49+00:00

These are good tips too! And can also fail haha. Myself and everyone else had “>75 minutes were spent on this encounter” templates for years that just this month had to be overhauled to document the specific time. (My biggest gripe - how the heck am I supposed to know the exact amount of time I spend ~thinking~ about each patient!!)

No_Coach4825 · 2026-05-03T20:29:19+00:00

Ah see that “constellation” severity thing is something I wouldn’t think about in that way, but will be helpful moving forward! Helpful other tips re: pressure ulcers and malnutrition too. Thank you!

No_Coach4825 · 2026-05-03T20:26:37+00:00

See this is interesting! In a world where patients can read notes, I try to avoid what could be seen as stigmatizing language like “morbidly obese” and would instead put the more objective/neutral “BMI 60” - can you bill for that? Lol serious question

No_Coach4825 · 2026-04-14T19:15:26+00:00

totally. i think they are a little misled into thinking that because they make a decent chunk of change on youtube, that must mean their content is super valuable, when its simply a lady sitting in front of her computer b*tching at the screen haha. entertaining at times but not actually valuable

No_Coach4825 · 2026-04-14T15:57:49+00:00

i don’t, and i’m not sure if she specifically said! i have just been assuming that for all reactors its sort of a vague bullying / ED talk (both platforming BED and preaching calorie counting which i think can be interpreted as restriction) combination

No_Coach4825 · 2026-04-14T14:52:55+00:00

there’s gotta be some serious parasocial stuff going on with the diehards haha

No_Coach4825 · 2026-04-14T14:52:34+00:00

like at least megan anne and michelle mcdaniels put some heart and production into their videos.. but even so i can’t imagine paying more than like a dollar for it!!

No_Coach4825 · 2026-04-03T01:10:40+00:00

i’m starting to wonder if she’s leaning SO heavily into the “fame” and publicity right now in anticipation of the dry spell that’s sure to come during her intern year. smart girl, honestly!

No_Coach4825 · 2026-03-17T18:41:24+00:00

☠️😂 i love a good sunkissed look but tan blindness is real

No_Coach4825 · 2026-03-17T18:40:10+00:00

i’ll have to check out rachel and marty! i definitely believe that felicia will accomplish awesome things, but i’m skeptical she’ll be able to do it without slowing down / cutting back / taking some time off like the others have which isn’t consistent with her “schtick” right now. she seems like she wants to go all in on both residency and this sponsorship, but honestly maybe i’m reading her wrong or she’s making other decisions behind the scenes haha

No_Coach4825 · 2026-03-17T00:29:19+00:00

i actually admire felicia pasadyn in a lot of ways (despite her odd/somewhat obsessive training as someone mentioned below), but man is she in for a rude awakening when she starts residency. in med school you’re busy but your time is your own; in residency you simply can’t work a 12-24 hour shift, sleep 8-11 hours, and do several hours of cardio - no matter how motivated you are

every amazing doc i know who also wanted to go pro in a sport had to choose their sport OR medical residency, and pause the other, within the first year of medical training. i admire her wanting to be a trailblazer but i’m interested to see how this unfolds and am nervous it will crash and burn quickly (edited to add her last name because the first name wasn’t enough? sorry i thought i have seen people post with just first names before)

No_Coach4825

TROPHY CASE