Has everyone had the opportunity to sample the ICD10 (international classification of diseases) which will soon replace the current idiocy (ICD9, oddly enough) mandated for physician billing? Specific codes are the aim, like some of these (actual billing codes):
Y92.152 Bathroom in reform school as the place of occurrence of the external cause
W220.2XD Walked into lamppost, subsequent encounter.
R46.1: Bizarre personal appearance.
V91.07XD: Burn due to waterskis on fire, subsequent encounter
W55.29XA: Other contact with cow, subsequent encounter
T63 Unspecified event, undetermined intent
Z63.1 Problems with and/or related to inlaws
S06.897D Other specified intracranial injury with loss of consciousness of any duration with death due to brain injury prior to regaining consciousness, subsequent encounter
Y92.146: Swimming-pool of prison as the place of occurrence of the external cause.
V97.33XD: Sucked into jet engine, subsequent encounter
Y92.253: Opera house as the place of occurrence of the external cause
V95.49XA Other spacecraft accident injury
Q55.64 Hidden penis
S30867A Insect bite (nonvenomous) of anus, initial encounter
T58.03 toxic effect of carbon monoxide from motor vehicle exhaust - assault
W61.22XA Struck by other psittacines, sequela
W56.12XA Struck by a sea lion
Y93D1 Stabbed while crocheting
Z03 - persons who present some symptoms or evidence of an abnormal condition which requires study, but who, after examination and observation, shows no need for further treatment or medical care
V95.43XS Spacecraft collision injuring occupant, sequela
Y92.241 Hurt at the library
T63 Unspecified event, undetermined intent
R46.0 Very low level of personal hygiene
Z73.4 Inadequate social skills, not elsewhere classified
VOMITING ALONE (787.03) (sad code)
You saved me from using T63 for everything, which was my intention. I will just have to stick with R46.1 (bizarre personal appearance, which pretty much describes me) or Z73.4 (inadequate social skills NOS - describes many of my coworkers). Most likely is z03 (patients who present some symptom…no need for further treatment or medical care…ie bye bye).
Most physicians won’t need to know the entire ICD-10 by rote, and most billing software already has ICD-10 coded in and sorted by specialty. Then docs and/or billers can pick and “favorite” the most common.
I suppose ER physicians might need W53.21XA (bitten by a squirrel, initial encounter) and V95.43XA (Spacecraft collision injuring occupant, initial encounter). But the average doc? Not so much.
Also, ICD-9 is 36 years old. It’s terribly out of date and has needed to be updated for decades. The procedure codes especially just don’t match current technology.
And if ICD-10 is still in use 36 years from now, something like “V95.43XA (Spacecraft collision injuring occupant, initial encounter)” might not seem so unlikely.
87.1 Vomiting with others (collaboration)
787.2 Vomiting on others (war effort)
787.3 Vomiting with others on others (a coalition of the nauseated)
787.4 Vomited upon by others (victimization)
787.5 Vomiting on self (the end of the line)
Of chief interest to me is the technology that would make “V97.33XD: Sucked into jet engine, subsequent encounter” possible.
But seriously, I’m wondering if this particular code is intended for maybe a coroner making return trips to the morgue to sort through the buckets of human bits and scrapings–just to verify cause of death, absence or presence of toxicity, etc. Or maybe he’s getting in the mood for a 787.3 party later that night.
There’s at least one case of someone being sucked into a jet engine and surviving. Still, one wonders what the point of having codes down to that level of specificity is. There can’t be more than a few cases in history, and as a practical concern in the few cases where it comes up, chances are the Doc is just going to end up using a more general code.
Wandering considerably off-topic, but as a performance poet I do a piece in which I ask for a specific sort of volunteer and then ‘stalk’ them through the audience before delivering the provocative final line nose-to-nose. I’d always supposed someone might punch me (though given the class of volunteer I was asking for, maybe not so much). The one time I actually felt scared was when I realised my volunteer was knitting at the time…
Z55.2 - Failed school examinations (Wait, that’s a medical condition now?)
Z60.4 - Social exclusion & rejection
Z31.69 - Encounter for other general counseling and advice on procreation
Z70.0 - Counseling related to sexual attitude
Z70.2 - Counseling related to sexual behavior and orientation of third party (I guess you now can be officially diagnosed as homophobic)
Z78.9 - Other specified health status
Z72.9 - Problem related to lifestyle, unspecified
Z75.0 - Medical services not available in home (Do most people have in-home medical services?)
Z75.9 - Unspecified problem related to medical facilities and other health care (Didn’t like the paint job?)
X32 - Exposure to sunlight (Wait, what?)
Y65.8 - Other specified misadventures during surgical and medical care
Y35.113 - Legal intervention involving injury by dynamite, suspect injured (Cops are now allowed to throw dynamite at you?)
F81.2 - Mathematics disorder
F12.90 - Cannabis use, unspecified, uncomplicated (How is that even a medical problem?)
F12.980 - Cannabis use, unspecified with anxiety disorder (That’s not what it does!)
F15.988 - Other stimulant use, unspecified with other stimulant-induced disorder (A very stimulating diagnosis I must say!)
F51.5 - Nightmare disorder (Take two aspirin and banish your sister to the moon for a thousand years)
F51.12 - Insufficient sleep syndrome (Which presumably can be resolved by getting more sleep)
R46.2 - Strange and inexplicable behavior
R86.3 - Abnormal level of substances chiefly nonmedicinal as to source in specimens from male genital organs
R99 - Ill-defined and unknown cause of mortality (When you don’t know what the !@#$%^ happened to your patient)
R69 - Illness, unspecified (The treatment for which, I presume, is “Treatment, unspecified”)
Q55.61 - Curvature of penis (lateral)
Q55.64 - Hidden penis (“I’m not really a girl.”)
Y65.52 - Performance of procedure (operation) on patient not scheduled for surgery (How did this happen?)
W26.1 - Contact with sword or dagger (ow!)
W30.81 - Contact with agricultural transport vehicle in stationary use (great-grandpa called this “Tripping over the hay cart”)
W21.07 - Struck by softball (at least it was soft)
Y71.0 - Diagnostic and monitoring cardiovascular devices associated with adverse incidents (“Sorry for dropping that EKG on you, buddy!”)
T63.443 - Toxic effect of venom of bees, assault (via the dogs with bees in their mouths and when they bark they shoot bees at you)
Y92.85 - Railroad track as the place of occurrence of the external cause (What were you doing there?)
Y92.531 - Health care provider office as the place of occurrence of the external cause (What to put down just before your patient sues you)
T62.1X1 - Toxic effect of ingested berries, accidental (unintentional) (What happens when you eated the purple berries)
T65.222 - Toxic effect of tobacco cigarettes, intentional self-harm (Also known as “smoking”)
T51.0X2 - Toxic effect of ethanol, intentional self-harm (One tequila, two tequila, three tequila, floor)
To be fair, most of the X, Y and Z codes were present before as E codes and weren’t used much. Yes, there are a few more but as somebody who once had to use code E906.3 (bite of other animal except arthropod) I was very unhappy to see that bite by rabid fox is STILL NOT included! (Best I can do is W55.81 bite of mammal NEC).
Personally, I am glad to see that you can now code for left knee pain separately from right knee pain and that the fact that there was one code for all brain tumors and multiple codes for breast cancers depending on the exact location of the tumor has been somewhat rectified.
Most doctors almost never bother to use the descriptive codes anyway. They’ll code for head contusion without bothering to mention that it occurred while playing Frisbee (which you could do under ICD-9).
