How Medical Coders Feel About Jargon Is Worth Knowing

by  Find-A-Code™
Jan 25th, 2023

A fascinating study recently published in the JAMA Network Open journal reveals what many of us have known for a long time: doctors and nurses speak in terms we patients often don't understand. Thus, we are confused by the medical jargon. It would be worth knowing how medical coders feel about it. Do they have trouble understanding clinicians?

If you are a medical coder or biller by trade, you know your main task is to convert electronic health records (EHRs) into ICD-10, ICD-11, and CPT codes. Everything you do has to be done through the lens of HIPAA compliance. But how often do you have trouble translating those EHRs? How often do you spend way too much time trying to decipher a clinician's meaning just so that you can choose the right code?

Jargon isn't exclusive to the healthcare industry. Every industry has it. But in healthcare, using jargon could actually be dangerous. The University of Minnesota researchers who conducted the previously mentioned study say that misunderstanding a doctor or nurse can actually lead to patient harm. In the billing department, misunderstandings merely lead to denied claims.

My Condition Is Occult?

NBC News' Erika Edwards produced a piece in late November 2022 discussing the University of Minnesota study. In that piece, she cited several examples of jargon that, at the very least, confused patients. One of the more interesting examples was the word 'occult'.

When a physician refers to a patient's condition as 'occult', they are referencing the fact that the condition was previously unknown or hidden. But to the rest of us, the word 'occult' conjures up images of witches, demons, and Ouija boards. Hearing a doctor refer to a condition as occult would lead many of us wonder if they were playing with a full deck.

Here are two additional examples cited by Edwards:

• Impressive – We tend to associate positive things with being impressive. When we say something is impressive, we are saying that it had a positive impact on us. But when a doctor says something is impressive – like chest x-rays or biopsies – it means they are concerned about what they see.
• Putting One to Sleep – A doctor might tell a patient that they intend to "put the patient to sleep" prior to a particular procedure. Imagine if that patient's only experience with the phrase relates to euthanizing a pet.

One of the physicians interviewed by Edwards for her piece mentioned the fact that clinicians suffer from "jargon oblivion." This is to say that they forget that they had to learn the terms they use in their daily practices. They forget that there was a time they did not know the terms either.

What Did the Doctor Really Do?

Take the same jargon mindset and apply it to medical coding and billing. Imagine being a medical coder trying to decipher a doctor's EHR relating to an obscure diagnosis or treatment. The coder is already at a disadvantage because they are faced with the diagnostic lookup of something they are not familiar with. If the doctor were not clear, a mistake could be looming on the horizon.

The coder might find themself asking, "what did the doctor really do during the office visit?" They might be left scratching their head trying to figure out terms they have never seen before.

According to the doctors interviewed by Edwards, the solution is as simple as clinicians choosing to speak in language that people understand. Simply put, it is to use simple English rather than industry jargon. It would be fascinating to know if medical coders and billers feel the same way.