I work in the ER doing charts (I have another real screen name here but don't want to use it considering the nature of this topic). I attended a mandatory "Coding" meeting today and it really got me thinking about priorities. For example, the first 10 minutes of the presentation the head of the coding group told us about a new "code" that would be like a free $10 in the doctor's pocket. It involves writing in the chart "I spent greater than 3 minutes counseling the patient about smoking cessation." But the subtext or "hidden message" was that in fact, we could "capture the code" (even in some pre-arranged acronym format) after speaking just a few sentences to the patient. When you find out they smoke - "You should stop smoking" and then upon discharge - "Here's a number to help you quit smoking." $10. The implicit message was, "We can capture this code without REALLY doing much work." Other more flagrant examples include the now defunct code "Under My Direct Supervision" - which was appended onto the documentation of fluids given in order to capture a few more dollars. "NS 1L IV given UMDS (under my direct supervision)" could be charged at a much higher rate than simply "NS 1L IV" - even though there was no difference in the care provided. I was instructed by doctors to "always" write UMDS when documenting fluids given, whether or not any additional supervision was occurring. Then when the code was no longer reimbursed at a higher rate, we were instructed to stop writing UMDS. Some people still write it reflexively! There are also issues with level 3 and 4 visits being artificially "bumped" to level 5 just to make more money (I have been instructed to do this). Am I missing something?