Robert Columbia, I would like to shake your hand (initial encounter, NOS, with sequelae). Are you also a Sermoan? Jack of Words - i was thinking of using them as a novel or epic poem, but you could probably make something much better of these.
There is one (I can’t find it right now) that is a subsequent encounter after exposure to nuclear war.
Psychobunny, were you not advised that you may not be reimbursed for the very general codes (headache, or brain tumor)? We were. Every detail counts, I’m told.
Oh yes, and the codes for “struck by duck” and “bitten by duck” are not the same.
If I ever end up being a doctor for some odd reason, I already know the code I would use exclusively - “Z72.9 - Problem related to lifestyle, unspecified”. Everyone gets the same one. It is perfect simplicity.
Oh ICD-10. So fun.
I recently finished school with classes focused on 10, but since implementation had been delayed a year just after I enrolled, I also got the fun of learning 9… 10 was way easier to learn. Now the company I work for has an internal program for coders to get some hands on experience before being thrown to work at actual facilities and it’s funny how many times we hear “yeah, you’re never going to use that code. I don’t even know why it exists”.
That being said, I’ve been working with medical records for 7-8 years and people have the most unlikely things happen… being partially degloved by an airplane, or falling on a cactus and pulling over a hot grill… I wouldn’t be surprised if there are specific codes for both of those scenarios now!
How do they come up with these really unlikely codes? Do people just sit around brainstorming every possible scenario they can come up with and assigning it a code in case it is ever needed or are they reverse engineered based on some type of database filled with millions of real cases?
What we were told is … no one knows how the payors will handle codes visavis payments so better to be as specific as possible (and to have the documentation in the note that justifies that specificity) just in case.
We have software that guides us … but it clearly would not guide us to some of those codes. And I cannot see how failure to identify that the burn was caused by water skis being on fire would impact getting paid at a level appropriate to the locations, degrees, and extent of the burns. I am also not sure why such extreme specificity was felt to be needed and wonder how often many of them will be used.
The other bigger push is to get better at bringing in (and documenting appropriately) the Hierarchical Condition Category (HCC) codes as those get used for population-wide risk adjustments. While this is most critical for the adult side dealing with Medicare, especially Medicare Advantage, even those of us on Peds with mostly PPO populations are advised to make sure we document and code appropriately and as specifically as possible to get credit for the level of illness that we address in our patient populations. Of course what gets labelled as an HCC diagnosis versus what does not does not always make much rational sense.
BTW folks “hidden penis” (a.k.a “buried penis”) is not a goofy one. Pediatric urology sees it all the time usually in toddler or high BMI preschooler boys (duh) and frankly probably do more procedures to address it than are really necessary. A penis of normal size for age is hidden inside the suprapubic fat pad which makes it appear very small of non-existent. Most commonly that fat pad goes away with growth and the problem resolves (explanation and reassurance to the parents is all that is required) but sometimes (rarely) there is a real issue with the skin of the shaft being short or adherent preventing the penis from coming out from its buried/hidden location.
When I was a radiology coder, we had to be very careful with coding because half the time, the patient’s insurance company would reject a claim for third-party billing information, which is fine when the patient has sprained an ankle or broken an arm, but sucks ass when the patient is a 80-year-old wheelchair-bound grandmother with arthritis. Reimbursement for plain-film X-rays is bad enough, but the insurance company makes you work for it.
I can’t find the code for “Knocked into rabid porcupine by windmill”.
Only by accident, though. Deliberately inflicted sword wounds would fall under X78 (sharp object, intentional self-harm) or X99.2 (sword or dagger, assault), I think.
I suppose W26.1 would have applied for a friend of mine. She was at a mutual friend’s house, waiting for an event to start, and examining a broadsword. She put it down unsheathed when she was suddenly called away to help with some preparations. When she came back, she bumped into the chair she’d set it across and stabbed herself in the knee with it. Her boyfriend, who had been planning to propose at the end of the event, ended up proposing to her at the hospital instead. Many “but then I took a sword to the knee” jokes were made.
People hurt themselves in the damnedest ways. A single incident from my childhood–one which lasted little more than a second–might have occasioned the use of any or all of these codes (and probably others, besides): W86.0, W25, W07, S00.03, T23.151A, T23.152A
You could make a game of sorts out of this: list an unlikely set of codes (ideally from some real incident), then let others try to piece together the narrative.
And, because this is important:
W13.4 = Fall from, out of or through window
Y01 = Assault by pushing from high place
So now we know the defenestration codes.
Is there a code for “walked into traffic sign, subsequent encounter”? “Walked into STOP sign, subsequent encounter”? Separate codes when the object was frozen vs not?
“You’ll shoot your eye out!” S05.50XD (Penetrating wound with foreign body of unspecified eyeball, subsequent enccoounter)
Frankly, I always considered sympathy chucking more of a cure than a disease. All those times I was sicker than I realized.
Oh my gosh. Now I’m imagining some action movie where these codes and the text of what they represent are read out any time a character gets hurt. That would be awesome.
Pathological dislike of Spam
Injury sustained due to use of falsified phrasebook
Injury by Møøse to family member - Sister
Patient in denial over death of parrot
Failure to predict Spanish Inquisition
Saying “Jehovah”
Turned into newt - Patient in recovery
Pathological desire for career change to Lumberjack - Patient ok.
All joking aside, the “subsequent encounter” codes are for the subsequent encounter with the physician, not a repeat of the event that got the poor unfortunate to the doctor in the first place.
So the first time Dr. Bones sees the patient who’d been sucked into the jet engine, s/he bills V97.33XA. For future visits, s/he bills V97.33XD.
By the way, MmeRose, for ICD9, I used569.42 as the main dx for all of my system testing.
I’ve always thought that physicians and other users send lists of the weirdest shit they’ve ever seen to WHO (which “owns” the ICD coding structure). ER docs and medical review staff at insurance companies are very popular.
Ok, that’s not exactly how it works, but ICD does accept requests. It’s somewhere on the WHO website. There’s probably some way it’s handled thru CMS, too.
Reverse-engineering claims data wouldn’t work because claims are billed with, well, existing codes, and believe me, no one wants to go through doctors’ written notes to get to this stuff.
What about smelling of elderberries? That might fall under the personal hygiene code. 
My advanced coding class was one of the few classes that made me want to cry. My final was more than three hours long and I was happy with the C+ I got.
My personal favorite code was F98.8- behavioral and development disorders. Covers a wide variety of things from nose-picking to excessive masturbation.
If you need more, I started a thread on this topic in January. My personal favorite:
If you have “acquired absence of right hand”, you’d need code Z89.111, while “acquired absence of left hand” is code Z89.112. And if you can’t tell which hand you’ve acquired an absence of, don’t worry: there’s a code for that too (Z89.119)
There are lists of symptoms for all these conditions as well.
Interested parties may want to check out The Illustrated Guide to ICD 10
Darn it! The ICD-10 playing cards are sold out :(.