How do I ask a patient their code status?
To ask a patient about their code status, use clear, direct, and compassionate language by framing the conversation around their goals, values, and what kind of emergency treatment they would or would not want.
Preparation and Approach
- Pick the right time: Have the conversation when the patient is calm, alert, and able to make decisions, ideally before an acute emergency occurs.
- Introduce the topic gently: Connect the question to their overall care, current illness, or hospital admission so it feels relevant rather than alarming.
- Avoid medical jargon: Explain terms like CPR, intubation, or mechanical ventilation using simple, everyday language.
How to Phrase the Question
- "We always like to know our patients' preferences so we can provide care that matches your wishes. If your heart or breathing were to stop, would you want us to do everything possible to try to restart it, including chest compressions and breathing machines?"
- "If you were very sick, are there treatments—like being put on a breathing machine—that you would want to avoid?"
- "What are your thoughts on CPR?"
Discussing the Options Clearly
Explain the main choices so the patient can make an informed decision:
- Full Code: Explaining that the team will use all emergency measures (chest compressions, electric shocks, breathing tubes, and medications) to try to restart the heart and breathing.
- Do Not Resuscitate (DNR) / Partial Code: Explaining that the patient can choose to decline certain interventions (like chest compressions or a breathing tube) while still receiving comfort care and other medical treatments.
Documenting and Confirming
- Listen actively: Allow the patient time to ask questions or express fears. Involve family members or a healthcare proxy if the patient requests it.
- Formalize the order: Ensure the preference is clearly documented in the medical chart or via an official state form (such as a POLST, MOLST, or DNR order) according to your facility's guidelines.
How do I ask a patient about their status?
To ask about a patient's status, use clear and direct language based on whether you need their code status (resuscitation preferences), mental orientation, or a general medical update.
Most healthcare professionals on Reddit agree that discussing critical care preferences should be routine and normalized during admissions.
1. Asking About Code Status (Resuscitation Preferences)
- Normalize the talk: State that you address this topic with every patient to remove fear or stigma.
- Ask what they know: "We like to talk about your preferences for medical care if your heart or breathing were to stop. What have you heard or thought about regarding CPR?"
- Explain options simply: Clarify choices regarding chest compressions, intubation, and comfort care without using confusing medical jargon.
2. Assessing Mental Status (Orientation)
To check if a patient is alert and oriented (A&O), ask four basic questions:
- Person: "Can you tell me your full name?"
- Place: "Do you know where we are right now?"
- Time: "What is today's date or the day of the week?"
- Event: "What brought you to the hospital today?"
3. Asking as a Family Member
- Call the main desk: Contact the hospital nursing station or patient information desk.
- Provide the password: Give the unique patient identifier or security code provided by your family member upon admission.
- Keep questions focused: Ask specific updates like, "Is the patient awake?" or "Have the latest test results come back?"
What is the code status of a patient?
You can review the full Noridian Patient Discharge Status Codes guide to see the two-digit numbers used on medical claims to show a patient's final location or status when leaving a facility.
Common Patient Status Codes
- 01: Discharged to home or self-care.
- 02: Transferred to a short-term general hospital.
- 03: Transferred to a Medicare-certified skilled nursing facility (SNF).
- 06: Transferred to home under home health care.
- 07: Left against medical advice (AMA).
- 20: Expired (the patient died).
- 30: Still a patient in the facility.
- 50: Discharged to home hospice care.
- 63: Transferred to a long-term care hospital (LTCH).
What to do if a patient is coding?
If a patient is coding (experiencing cardiac or respiratory arrest), you must immediately call for help, check for a pulse, and start high-quality chest compressions.
Immediate Critical Steps
- Assess and Call: Check responsiveness and look for a carotid pulse. Hit the code blue button, call for help overhead, and state your exact location. Lower the head of the bed.
- Start CPR: If there is no pulse, begin chest compressions immediately at a rate of 100 to 120 beats per minute, pushing hard and fast. Do not delay compressions even if you are unsure about a pulse.
- Secure Airway and Breathing: Open the airway and provide bag-valve-mask ventilations as soon as equipment or additional team members arrive.
- Check Code Status: Verify whether the patient has a valid Do Not Resuscitate (DNR) order; if unclear or unavailable, initiate resuscitation immediately until status is confirmed.
- Defibrillation and Medications: Retrieve the code cart, apply defibrillator pads to check for shockable rhythms (like V-fib or pulseless V-tach), and prepare ACLS medications like epinephrine.
- Delegate Roles: When the code team arrives, assign clear roles (compressor, airway manager, recorder, medication nurse) to maintain an organized and efficient response.
How do I ask a patient about code status?
You can guide a code status conversation effectively by using the step-by-step framework outlined by the Palliative Care Network of Wisconsin.
1. Prepare and Normalize
- Sit down next to the patient to build trust and ensure privacy.
- Normalize the topic so the patient does not feel singled out or overly scared.
- Example: “I have one more topic to discuss with you. It is something I discuss with every patient I am admitting to the hospital, regardless of how healthy or sick they are.”
2. Assess Understanding
- Check for prior directives or explore what the patient already knows using open-ended questions.
- Example phrasing: Ask if they have an advanced directive or what they understand by terms like "code status".
3. Define and Explain Clearly
- Avoid vague phrasing like asking if they want "everything done". Instead, provide a concrete explanation of CPR (such as compressions and breathing machines) and realistic survival outcomes.
- Example phrasing: Share specific statistics or ask how their personal values align with undergoing medical interventions for a chance at recovery.
4. Listen and Document
- Respond with empathy, validate emotions, and center the conversation around the patient's personal goals.
- Finalize documentation in the medical record and reassure the patient that choices can be adjusted as their health evolves.
New Nurse Tips | Discussing a Patient's Code Status
What questions to ask to assess patient status?
When a patient is admitted to a healthcare facility, their medical condition is summarized using specific, standardized categories. Here are the standard patient status classifications used by hospitals, along with the key questions frequently asked about them.
Standard Patient Status Definitions
The American Hospital Association (AHA) guidelines generally break patient status down into four main categories:
- Undetermined: The patient is still being evaluated. No status is available yet.
- Good: Vital signs (like heart rate, blood pressure, and breathing) are stable and within normal limits. The patient is conscious and comfortable. Indicators are excellent.
- Fair: Vital signs are stable and within normal limits. The patient is conscious, but may be uncomfortable or experiencing minor complications.
- Serious: Vital signs may be unstable or outside of normal limits. The patient is acutely ill, and clinical indicators are questionable.
- Critical: Vital signs are unstable and outside of normal limits. The patient may be unconscious. Indicators are unfavorable, and patients are typically in an Intensive Care Unit (ICU).
Common Patient Status Questions
1. What is the difference between "Serious" and "Critical" status?
- Serious means the patient is very ill and their indicators are doubtful, but they are not necessarily on the brink of standard organ failure.
- Critical means the patient's life-threatening symptoms require immediate, continuous medical intervention, often involving life-support machines.
2. Does "Stable" count as a patient status?
No. Clinically speaking, "stable" is not a formal patient status on its own. It is a qualifier used to describe vital signs that are not changing rapidly. A patient can be in "critical but stable" condition, meaning they are very sick, but their condition is not actively worsening at that moment.
3. Who is legally allowed to receive patient status updates?
Under privacy laws like HIPAA (in the United States):
- General Public: If a person asks for a patient by name, hospitals can usually release a one-word condition update (e.g., "Good" or "Fair") unless the patient has opted out of the hospital directory.
- Detailed Info: Detailed medical updates can only be given to individuals designated by the patient, such as a legal proxy, next of kin, or someone on an approved contact list.
4. How often are patient statuses updated?
Statuses are dynamic and updated by the attending medical team as the patient’s condition changes. For critical patients, updates happen continuously. For stable or recovering patients, statuses are usually reviewed during morning or evening physician rounds.
What is a medical status code?
A code status is a formal medical order that states what type of emergency life-saving treatments a patient wants or does not want if their heart or breathing stops.
Common Types of Code Status
- Full Code: Directs medical staff to use every possible life-saving measure—such as CPR, chest compressions, electric shocks, emergency medications, and a breathing tube—to restart the heart and lungs. This is typically the default status if no other order is written.
- Do Not Resuscitate (DNR): Directs staff not to perform CPR or chest compressions if the heart stops, allowing a natural death, though other ongoing medical care is still provided.
- Do Not Intubate (DNI): States that the patient does not want a breathing tube or mechanical ventilation, though other resuscitative efforts may still be allowed.
- Comfort Care / Comfort Measures Only: Focuses entirely on pain control, breathing ease, and dignity at the end of life, withholding aggressive life-sustaining interventions.
What are the different types of code status?
A code status is a medical order that tells healthcare providers what life-sustaining treatments a patient wants during a cardiac or respiratory arrest.
The main types of code status include:
- Full Code: Medical teams use all life-saving interventions, including Cardiopulmonary Resuscitation (CPR), chest compressions, defibrillation (shocking the heart), emergency medications, and intubation (placing a breathing tube). This is the default status if no other order is documented.
- Do Not Resuscitate (DNR): Medical teams will not perform CPR or chest compressions if the heart stops or breathing ceases. Depending on other specific orders and state guidelines, other medical treatments may still be provided before an arrest occurs.
- Do Not Intubate (DNI): Medical teams will provide chest compressions or other resuscitation efforts, but they will not place a breathing tube or put the patient on a mechanical ventilator. A patient can have a DNI order without a DNR order.
- Comfort Care / Comfort Measures Only (CCO): Medical teams stop aggressive life-prolonging treatments and focus entirely on pain relief, symptom management, and dignity. Resuscitation efforts like CPR and intubation are not used.
What are the four types of patient status?
The four types of patient status in medical coding and healthcare administration are new patient, established patient, outpatient, and inpatient.
The Four Status Types
- New Patient: Someone who hasn't received face-to-face services from the provider (or same-specialty colleague in the group) in the past three years.
- Established Patient: Someone who has seen the provider (or same-specialty colleague in the group) within the last three years.
- Outpatient: Someone receiving treatment without formal admission, such as in a clinic or emergency room.
- Inpatient: Someone formally admitted to a facility for ongoing care.
For comprehensive billing rules, see the Evaluation and Management (E/M) Study Guide.
What is status code in medical coding?
Status codes in medical coding are special ICD-10-CM Z codes from Chapter 21 that describe a patient's current, ongoing physical condition, device use, or past procedure that affects future healthcare.
What is a Status Code?
- Current vs. History: Status codes mean the condition or device is present right now. History codes mean a past condition is fully gone.
- Impact on Care: They explain why a patient needs specific care or how providers must adjust treatments.
- Documentation: Doctors must note these conditions clearly in the medical record so coders can report them.
Common Types and Examples
- Organ Transplants: Show ongoing anti-rejection care or organ presence (such as Z94 for kidney or heart transplant status).
- Artificial Openings and Devices: Report items like pacemakers, stents, or ostomies (such as Z93 for colostomy status).
- Long-Term Medication: Track ongoing critical drugs (such as Z79.4 for long-term insulin use).
- Limb Absence: Note missing parts of arms or legs (such as Z89 for acquired absence of a foot or leg).
Basic Rules for Coders
- No Duplication: Do not use a status code if a regular disease code already includes that exact information.
- Support Medical Necessity: Use them to prove why a screening or routine checkup happened.