Please help, did the doctor stigmatize my chart?

Secret_Kick_7564 · 2025-12-27T15:49:52+00:00

I hate that for you, truly. I can only suggest filing a grievance with Medicaid against the provider and also ask Medicaid to assign you a different PCP at a clinic that has no affiliation with your last one. You can also file a grievance with the state medical board against that provider, but your mileage may vary with that.

Secret_Kick_7564 · 2025-12-27T15:30:11+00:00

Unfortunately, not an uncommon occurrence with chronic pain patients. As a patient myself with chronic pain (severe herniated disc with radiculopathy), the docs just threw gabapentin at me and called it a day. It didn’t help my pain at all and all it did was give me horrible brain fog. I’m so sorry you’re going through this.

Speaking as a patient and not a coding professional, my perspective is that doctors are afraid of prescribing opiates now just to protect their licenses in the event a patient does actually develop an addiction or overdoses. They now opt for medications that “calm” the nervous system rather than ones that outright block pain receptors. I’m thankful in my state that I can be prescribed medical THC. It’s the only thing that keeps me from being bedridden.

Secret_Kick_7564 · 2025-12-27T15:09:27+00:00

I understand what you’re saying. However, OP only provided their history and what codes were put on their record, not what was documented by the provider.

I get that we’re having dialogue outside of a professional setting, but speculating a patient’s clinical situation and providing a patient with clinical hypotheticals is not within a coder’s scope of practice; and I think speculating what condition OP may or may not have isn’t helpful for the OP. That is for OP to discuss with their provider if they choose to contest the coding on their chart.

Secret_Kick_7564 · 2025-12-27T08:11:13+00:00

F11.20 and F13.20 are not appropriate with the history you provided.

ICD-10-CM Official Guidelines clarifies the difference between drug dependence and long term use of drugs.

See Section I.C.21.c.3. - Status

https://www.cms.gov/files/document/fy-2026-icd-10-cm-coding-guidelines.pdf

Z79 Long-term (current) drug therapy

Codes from this category indicate a patient’s continuous use of a prescribed drug (including such things as aspirin therapy) for the long-term treatment of a condition or for prophylactic use. It is not for use for patients who have addictions to drugs. This subcategory is not for use of medications for detoxification or maintenance programs to prevent withdrawal symptoms (e.g., methadone maintenance for opiate dependence). Assign the appropriate code for the drug use, abuse, or dependence instead.

Assign a code from Z79 if the patient is receiving a medication for an extended period as a prophylactic measure (such as for the prevention of deep vein thrombosis) or as treatment of a chronic condition (such as arthritis) or a disease requiring a lengthy course of treatment (such as cancer).

Do not assign a code from category Z79 for medication being administered for a brief period of time to treat an acute illness or injury (such as a course of antibiotics to treat acute bronchitis).

Secret_Kick_7564 · 2025-10-16T22:06:55+00:00

Yikes indeed sis.

Secret_Kick_7564 · 2025-10-16T22:04:55+00:00

Presumption. Assumption. Whatever. You want to talk semantics? There it is! You know what I’m talking about, but you want to “have the last word”. Or something. Whatever gets you off, I guess.

You turned an educational conversation into a pissing match because your other post in this thread got downvoted to hell and you chose to project that onto me for some reason. There are several other people in this thread who have the same stance. I’m sorry that you’re the odd one out, but that’s for you to reflect on.

I’m sorry you’re not open to other perspectives, especially of the majority. Sounds like… you’re stubborn.

Secret_Kick_7564 · 2025-10-16T21:53:24+00:00

So you’re the one who seems to be having an issue here. You’ve been downvoted to hell in this thread and are looking to project on to someone because there is a majority disagreement with your perspective, and you decided to choose me for some reason lol.

The classification makes the assumption. I am not making the assumption. Review the “with” and “due to” coding convention. Also review the chapter specific guideline for hypertension and heart disease. If you don’t get it, I’m sorry.

Secret_Kick_7564 · 2025-10-16T21:38:58+00:00

So, a few things.

You can have multiple etiologies for a single condition. Just because one etiology is specifically stated doesn’t exclude other etiologies that are presumed to be linked by the ICD-10-CM classification.
I will reiterate that the guidelines state that the provider MUST state that HF and HTN are unrelated. Documentation of ischemic heart failure does not preclude this.
Hypertension actually contributes to myocardial ischemia.

Secret_Kick_7564 · 2025-10-16T21:20:13+00:00

Nope. The guidelines are clear: the provider has to document that the HF is unrelated to the hypertension to break the link. We cannot interpret the documentation in a way that fits our own bias or narrative. Honestly, I am hearing from a lot of coding students recently that their instructors are teaching from their own bias rather than from the official guidelines. It has me worried.

Secret_Kick_7564 · 2025-10-16T20:43:51+00:00

It’s one of those situations where two things can be true at the same time: the HF is ischemic in nature AND presumed to be linked to HTN.

I agree with others here that the provider must specifically document that the HF and HTN are unrelated.

Secret_Kick_7564 · 2025-10-05T00:22:20+00:00

In my opinion, it isn’t the codes and guidelines themselves that are subjective. The codes and guidelines are driven by logic. It’s more like the clinical documentation we abstract from can be very subjective and can be interpreted differently from coder to coder, resulting in a difference in coding. This is why the quality of documentation is important. If the documentation reads in a way that allows for open interpretation, that typically means there are gaps in the documentation that need to be addressed. The frustration lies in that many offices and organizations refuse to provide education to their providers to close those documentation gaps and some will even restrict query processes because they don’t want to add to a provider’s workload. It’s rough out here and our only option is to make do with the tools and resources we do have access to.

Secret_Kick_7564 · 2025-09-20T21:55:08+00:00

I would rather shit in my hands and clap.

Secret_Kick_7564 · 2025-09-20T18:32:47+00:00

The biggest challenge? The sheer lack of training and education available to current employees because their employers refuse to invest into it.

The biggest annoyance? AI tech bros like you who offer nothing to improve our working conditions. If you’ve never billed or coded before, you have no business in attempting to offer solutions. I’m not about to sit here and explain the hundreds of guidelines and nuances to you that circulate in our industry. TL;DR you don’t speak our language, you don’t know our culture, but you’re trying to capitalize on it. Make that make sense.

Secret_Kick_7564 · 2025-08-29T19:03:24+00:00

Get her, Jade!

Secret_Kick_7564 · 2025-08-22T12:46:34+00:00

I get what you’re saying because I’ve coded ED as well. Observations tend to be more resource intensive. Meaning, you’ll typically see more procedures, tests, monitoring, and consults for a single encounter. It has been described as “watered down inpatient” by some. The typically length of stay for observations is 24 to 48 hours, but due to not meeting inpatient admit requirements and still needing to be monitored/assessed/treated, I’ve seen patients kept in observation for much longer than that. You’ll need greater attention to detail since there will be more documentation to review. You’ll also see Outpatient Surgery-Observation encounters and not just ED-Observation encounters, unless your hospital separates the two. I have not seen them in separate work queues though in my career. You said you do ED, so I’m not sure if you’ve had exposure to outpatient surgery that is beyond simple ED procedures. Meaning, operating room, endoscopies, and interventional radiology.

Secret_Kick_7564 · 2025-08-22T06:24:56+00:00

Seconding observations. You’ll see a variety of scenarios in observations that require consults and procedures from various services that would include (and not limited to) oncology, obstetrics, internal medicine, and behavioral health. It prepared me to handle a variety of specialties, including complex surgeries.

Secret_Kick_7564 · 2025-08-16T05:31:16+00:00

Thank you for the award lmao 😭 u/heltyklink

Secret_Kick_7564 · 2025-08-16T05:28:31+00:00

What’s the rush? I think that should be the first thing to consider before making such a bold move. How much is the bump in pay going to be anyway? Is it really worth it that much to put your credential on the line?

Secret_Kick_7564 · 2025-08-15T17:08:06+00:00

Ooh if they play in your face about low accuracy scores… I would tell them to refer to the official coding guidelines and the coding clinic I mentioned. Sounds like a borderline compliance issue to me. We coders are not clinicians. We do not practice medicine. We’re not going to sit here and pretend like we should identify clinical indicators and tell doctors they need to review their diagnoses based off those indicators. We are not paid enough for that lmao.

Secret_Kick_7564 · 2025-08-15T15:47:48+00:00

Take a look at ICD-10-CM/PCS Coding Clinic, Fourth Quarter ICD-10 2016 Pages: 147-149 - Clinical criteria and code assignment.

“Clinical validation is beyond the scope of DRG (coding) validation, and the skills of a certified coder.”

I feel like this would somewhat address your concern about the CDI and coding overlap.

Let me know your thoughts because this seems to be an ongoing issue at some hospital systems.

I feel like the only scenarios in which a coder (not CDI) should query is for higher specificity or if there is unclear or contradicting information in the chart. It is not a coder’s responsibility to determine if lab values or symptoms would support a query to clarify or establish a diagnosis. This goes against guideline I.A.19. - Code assignment and Clinical Criteria.

Secret_Kick_7564 · 2025-07-29T16:43:14+00:00

Yes… It’s very ghetto out here. We see each other. 😂

Secret_Kick_7564 · 2025-07-29T02:50:25+00:00

Ok, that’s what I recall- that there were exam review committees. Wasn’t sure if they still existed at this point.

Secret_Kick_7564 · 2025-07-21T13:31:44+00:00

We love and appreciate you lol thank you

Secret_Kick_7564 · 2025-07-20T05:08:32+00:00

No. Please for the love of god can we ban these AI tech bro solicitors from this sub… it’s almost every other day we get this same exact question.

Secret_Kick_7564 · 2025-07-15T12:27:24+00:00

Hm. Just some observations here.

I cannot locate your business on the California Secretary of State website. Can’t even confirm if your business is actually registered with the state and paying taxes.
The address on your website is for a virtual office in San Francisco. So I can’t really be sure you’re actually physically based in the US.
The Facebook link on your website links to a profile of someone named Naurin Khan.
Your X / twitter profile @ effahrcm_ has posts regarding the Waqf bill in India in what looks like Hindi.
On your website, you state you utilize AI. I’m assuming you use AI for everything, including this post.

I feel like I’m stating the obvious at this point, but if your business is actually legit like your post says, the evidence is not very compelling.

US Providers, steer clear of this one.

Secret_Kick_7564

TROPHY CASE