Decision Fatigue: Is There a Code for That?

Let’s talk about the mental side of being a coder – and the stress that quietly (or not so quietly) tags along with it.

Every day, coders are asked to make what feels like thousands of decisions. Did the physician clarify that suspected diagnosis in the discharge summary, or was it left hanging in limbo?

The provider keeps documenting a urinary tract infection (UTI), but the culture came back negative; do we code it or query it? Condition A and Condition B both seem to justify the admission, but which one gets sequenced first?

The questions keep coming, and that’s just before lunch.

Then, after clocking out, the real-life decisions kick in:

• What’s for dinner?
• Do the kids have practice?
• Should I walk the dog, or just pretend I don’t see her waiting by the leash?
• Laundry or dishes? (Spoiler: neither sounds appealing.)

At some point, the brain simply short-circuits, and the only thing you feel qualified to decide is what Netflix show to fall asleep to. Recently, I came across a term that sums up this feeling perfectly: decision fatigue.

According to Google’s trusty Copilot, decision fatigue is a “psychological phenomenon that occurs when a person makes numerous decisions in a short period, leading to psychological and emotional exhaustion. It results in a deterioration in the quality of decisions made, as the mental strain from the burden of choices can deplete one’s ability to make sound judgments.”

Yep. That’s me by 6 p.m.

And because I’m a coder, through and through, my next thought was, “Is there a code for that?”

Naturally, I opened the Index. If we look up exhaustion, mental, it leads us to F48.8: Other specified nonpsychotic mental disorders. Sounds pretty accurate. My spouse might even say it’s spot-on. Then there’s burnout (hello, old friend), which brings us to Z73.0: Burnout, defined as “a state of emotional, mental, and physical exhaustion causing difficulties in managing personal, school, or work circumstances.”

 Anyone else feel personally attacked?

For good measure, I looked up “stress” too. There’s Z56.6 (Other physical and mental strain related to work) and Z56.3 (Stressful work schedule). Honestly, I could probably justify all of them on my personal medical record.

But let’s be real: even though we joke, decision fatigue is real, and it impacts our performance and our peace of mind. So, how do we deal?

Well, short of winning the lottery and retiring to a tropical beach, here are a few more realistic ideas:

• Take mini breaks. Step away from your screen, stretch, go outside for a few minutes, or just take some deep breaths.

• Snack wisely. A healthy snack you actually enjoy can do wonders for morale

• Listen to something calming. Whether it’s lo-fi beats, nature sounds, or smooth jazz, a relaxing playlist can soften the edges of a stressful day.

• Set boundaries. If possible, create start and stop times for your workday – and stick to them.
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• Laugh a little. Humor might not be in the Index, but it should be. It helps. A lot.

Now if only there were a code for Coder – Unstressed and Relaxed. I’d definitely take credit for that one.

About the Author: Ms. Combs joined First Class Solutions, Inc.^sm in 2021. She brings a positive and jovial personality to her daily work. She supports three clients on a routine basis, including a specialty organization with multiple locations, a multi-campus community Integrated Delivery Network (IDN), and a nationally recognized research entity with a unique and challenging case mix. With extensive experience in medical coding, auditing, and transcription, Amy Jo has both inpatient and outpatient coding experience. She has been responsible for providing education to new and experienced coders, auditing for all types of inpatient records, and providing coding support.