Yeah, I didn’t work in nephrology (or endocrinology?) but we had analogous diagnoses in our practice. It’s weird but that’s likely ‘working as intended’. Some of our patients were freaked out with chemotherapy codes on the EOBs, but as there was nothing more specific in the code book, and I triple checked with insurers and manufacturers of the drugs we administered, that was actually appropriate billing.
~Max
R09.81-nasal (and sinus) congestion
R51.9-unspecified headache
J34.9-unspecified disorder of nose and nasal sinuses
There is a code for almost everything:
S01.23XA/W29.8 (this is the code for accidentally puncturing your sinus with a hand-held electric drill, initial visit).
Actually apparently this is also the code if you do it deliberately while trying to do your own sinus surgery.
The fact that there is a code for this says so much about humanity.
Humans denied my referral to a urologist because the referral did not come from my PCM but front another doctor in the same office.
The cancer spread to my lymph nodes and resulted in 9 weeks of chemo and two major surgeries. One of the doctors involved in the first surgery was out of network so I was on the hook for $10000.
They should have a whole category just for Jackass stunts.
Some jackass-type codes
W16.532A-jumping or diving into swimming pool striking wall causing injury
T21.06XA/W40.8XXA-injury to male genitals causes by explosive material not otherwise specified
S09.90XA/Y93.T1-injury to head and face caused by injury while riding a roller coaster
T61.8X2A-toxic effect of other seafood intentional self-harm initial encounter (this is the code for eating improperly prepared fugu)
I almost feel like at some point someone on the show could have gotten hold of these codes, browsed them, and thought, “These should be in the next episode!”
This sounds pretty much like insurance fraud. If a mechanic regularly did this with the cars they serviced, they’d probably be looking at jail time.
This is exactly what I’m complaining about. People (not the doctors themselves in most cases) are going through visit notes and patient history to see what they can plausibly bill for, just short of being on flagrantly bad faith.
And with the increase in deductibles in many plans, the health insurance companies are not on the hook for most of these charges. The patient is. In fact when creatively recharacterizing screenings as E&M they actually help the insurance company pay less! Win-win!
T18.5XXS: foreign body in rectum
V97.33: sucked into a jet engine and lived to tell about it (yes, this has happened)
W56.21XA-bitten by orca, initial encounter (no explanation why bear bites are by mammal not otherwise specified but orcas are singled out with their own codes)
V90.27XA-drowning or submersion due to falling or jumping from burning water skies, initial encounter
509.20XA/Y93.J4-traumatic rupture of unspecified eardrum while playing brass instrument, initial encounter
“Initial encounter?” Are W56.21X B thru Z “man this guy sure does get bitten by orcas a lot”?
Injury codes have:
-initial encounter XA
-subsequent encounter XD
-sequelae XS
Weirdly, I now feel like my life is really boring.
Again, these are the jackass codes.
The weirdest one I actually had to use was
Z20.3/W55.81XD- bitten by rabid fox (technically, exposure to rabies caused by the bite of a mammal not otherwise specified, subsequent encounter).
Just a few more:
W20.8/Y92.251-struck by falling object in museum
W55.32/Y93.K3- kicked by a sheep while shearing
V100.152-heelies colliding with stationary object
W58.03/Y92.156-crushed by alligator in swimming pool of reform school
Are these jokes or real codes?
They seem to be real. Googling W58.03 pulls up this site that confirms that code is “crushed by an alligator”, and googling Y92.156 pulls up “Code for Swimming-pool of reform school as the place of occurrence of the external cause”.
That’s the initial encounter with the doctor, not the orca.
ICD10 is hilarious, but the funny ones never get used in real life.
The codes are real. It’s just that they are randomly and oddly specific. There is a code as I noted, for being bit by an orca or a dolphin but bear bites just go under mammals that are not cats or dogs. People rarely use the qualifying codes that specify place or situation but there are indeed separate codes for a swimming pool of an apartment complex versus a regular school versus a reform school versus a prison. Watercraft are also oddly specific. I am not sure why it matter if you drown after falling from a sailboat or a canoe or if a statue falls on you in a museum versus an art gallery versus a private home but the codes do exist.
I will admit to owning a deck of cards with the most bizarre codes. I actually didn’t even consult it for these but I do think that water-skis on fire is listed.