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Using ICD-9 Codes To Describe Your Morning


6:00 AM

Alarm goes off.  Hit snooze button. CIRCADIAN RHYTHM SLEEP D/O IRREG SLEEPWAKE TYPE ICD-327.33


  • Alarm goes off for third time.  Ready to hit snooze button, but knee in ribs from wife prevents more snooze button procrastination.  CONTUSION OF CHEST WALL ICD-922.1, ADULT MALTREATMENT UNSPECIFIED NEC ICD-995.8
  • Feeling tired, go to make a pot of coffee. CAFFEINE ADDICTION ICD-304.40
  • Fill bowl with Lucky Charms and start eating. UNSPECIFIED NUTRITIONAL DEFICIENCY ICD-269.9, HYPERGLYCEMIA ICD-790.29


  • Realize that coffee pot needs to be turned on for it to make coffee. ATTENTION DEFICIT DISORDER, ADULT ICD-314.00, LISTLESSNESS ICD-780.79
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*This blog post was originally published at Musings of a Distractible Mind*

Beyond the Five-Digit Codes: The Art of Putting Patients First

By Steve Simmons, M.D.

Last week my partner wrote about The Funnel, and illustrated how patients are squeezed through a healthcare system that focuses on specific problems without allowing enough time to treat patients as individuals.  We have shown how frustrating this is for doctors and demonstrated that a shortage of primary care physicians is a reality.  However, we don’t believe it’s too late to reverse this foreboding trend. Today, my partner and I at doctokr Family Medicine are building a practice to care for our patients as individuals first.  We have also added our voice to a growing chorus of physicians sounding ever louder, explaining the necessity of a healthcare system that places the art of caring for patients first.

The next time you sit in a doctor’s waiting room, look around and consider what, and more importantly who, you see.  You might see a sick child or his worried mother. Our healthcare system does not see two people, rather it sees a 5-digit CPT and ICD-9 code.  ICD-9 (International Classification of Diseases) codes were originally created by the World Health Organization (WHO) to track diseases across the globe. Today, CPT codes (designating patient difficulty) are combined with the ICD-9 codes by third-party providers to standardize the reimbursement process. Although over 17,000 ICD-9 codes exist to classify various illnesses, there is no code for compassion. More concerning, the system does not allow any time to ease the worries or fears of a mother.

The focus of a primary care doctor’s medical practice should be on the art of patient care. An individual should be treated as a whole and not the combination of their individual problems.  But, a time may come when we must focus on one specific medical problem and seek the help of a specialist; such as an endocrinologist for diabetes or an orthopedist after an accident.  Yet, without a primary care physician to coordinate our care and speak on our behalf, a patient’s wants and needs as an individual might not be considered in reaching a particular treatment decision.  I can speak as a doctor, son, or patient when I say that anyone’s health can suffer at the hands of brilliant physicians working without the guidance of a coordinating physician who knows us well.

My mentor in medical school was an experienced family physician near retirement who offered me the following insight.  There are two types of doctors and I would consciously or sub-consciously choose which one to be.  One type of physician makes medical problems central in their patients’ lives and thus forces the individual to revolve around their problems.  The other type works to keep the patient’s life central and tries to make problems rotate around the individual.

Those policy makers determining the future of healthcare should follow my mentor’s advice.  Today’s health-care system has devolved to focus solely on problems and disease, often to the detriment of individuals and families.  As decision-makers explore revamping our current healthcare system they could continue, unaware, in this same direction. But, I have to believe they would choose the other direction if they could remember how it feels to sit in a doctors waiting room surrounded by other people – individuals all.  Nothing will change the fact that healthcare is ultimately about people, and not codes or a specific problem.  Healthcare should help patients and their primary care doctors make good health and wellness decisions while basing them on an individual as a person.

Until next week, I remain yours in primary care,

Steve Simmons, MD

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