Monday, 21 March 2016

ICD-10

Everyone in the medical world knows that medical coding is a pain in the ass.  To anyone not in the medical world, you'll just have to trust me - medical coding is a pain in the ass.  We go by a list of codes called the International Statistical Classification of Diseases and Related Health Problems (no seriously, that's actually what it's called) that is maintained by the World Health Organisation and has been updated periodically since its creation in 1949.  The 9th version contained about 13,000 codes (yes, 13,000) for every diagnosis imaginable.  Well, almost.  Obviously they didn't think 13,000 was quite detailed enough because the 10th version, which was completed in 1992, expanded this to some 68,000 codes.  A total of 27 countries over the flat plane of the Earth use ICD-10: the Czech Republic adopted ICD-10 in 1993, UK in 1995, Canada in 2002, France in 2005, and the USA came in dead last in 2015.

Come on United States, it's like you're not even trying.  Fahrenheit?  Really?  Inches?  Gallons?  Do try to keep up with the rest of the world, America.  I bet even the eels from Ceti Alpha V use metric.

Anyway, some examples of codes that I use are S06.0X1A (Concussion with loss of consciousness of 30 minutes or less), K35.3 (Acute appendicitis with localised peritonitis), and S36.116A (Major laceration of liver).  But while perusing this thoroughly entertaining (not really) book you can also find codes for everything from W55.21XA (Bitten by cow) and W61.33XA (Pecked by a chicken) to Z63.1 (Problems in relationship with in-laws).

Ha ha!  Hilarious!  Pecked by chicken!  Problems in relationship with in-laws!  Don't we all!  Ha ha!  Good one, Doc!

What's that?  This sounds ridiculous and these codes couldn't possibly be real?  You think I made these up?  Then I challenge you to click the links and enjoy now having the knowledge that someone at WHO thought that there was adequate reason for these codes to exist.

Trauma is a bizarre world.  The patients are bizarre, the stories are bizarre, the injuries are bizarre, the situations are bizarre, and nothing seems to fit into any kind of pigeonhole of any kind ever.  Of course I'm exaggerating for the sake of drama and interest, because otherwise who the hell would read this crap.  In reality the majority of my patients are car accident and fall victims who have minor bumps and bruises and go home.  

But we do get the truly strange, the outlandish, the "What The Fuck Happened" cases from time to time, and those are the ones that stand out and are highlighted here.  Obviously.

This one fits.

Alan (not his real name™) was kind enough to relate a story that happened to him and a few friends recently.  I'll preface this by saying that Alan and his friends are university students, and as anyone who ever went to college knows, college students are stupid immature and impulsive, and anything can happen.  Anything.
Hey, Doc, I first heard of you via comments from FML and recently started reading your blog. I've enjoyed it very much and wanted to share with you a story that happened during my freshman year of college. 
My suitemate and I got back to our dorm around 3 AM one morning.  My roommate Brandon (not his real name™) was in my room with two other friends.  When we walked in, Brandon was sitting on his bed, and Aaron was sitting on my bed, talking.  Brandon walked over to us when we came in, and started talking to Mike.  At this point, I had my back to the others, and they filled me in with what happened after. 
Apparently before I got back, Aaron had taken Brandon's can of Febreze and was using it on his shoes (he's a soccer {that's football for the rest of the world} player).  I then hear Aaron say, "Hey, Brandon, look what I have!"  Then Brandon replied, "Give me that back!"  I then heard a thud. 
I turn around and see Brandon lying on the floor face-down.  I initially thought that he was just playing around, as is usual for him.  I said, "Ok, Brandon, get on up."  Upon receiving no response, I shook his shoulder.  "Brandon. Brandon!" Still nothing, so I turned him over, only to see blood coming from his forehead.  "What did you guys do to Brandon?!?" I exclaimed.  Aaron then explained that after Brandon demanded his Febreze can back, he tossed it to him under-handed.  Brandon apparently dove towards him, thinking that Aaron wasn't going to give it to him.  Somehow, the Febreze can connected with his head, and it knocked him out completely.
Try as we might, we couldn't rouse him.  Eventually, a fire EMT crew showed up and managed to wake him momentarily.  Shortly after, a few policemen showed up along with a regular EMT crew.  The police of course were grilling all of us concerning what caused it, repeatedly asking if we were drunk or high (which none of us were, though understandably we had a hard time convincing the officer otherwise).  Brandon ended up being taken to the hospital.  Though I'm not sure where exactly he was hit, apparently according to the ER staff it shouldn't have knocked him out, especially for as long as it did (nearly half an hour), considering what he was hit with, and how weakly it was thrown.  They all had a good laugh when they found out that the object that he was knocked out with was a pink Febreze can.
I diligently searched the approximately 947,502,485,503 ICD-10 codes, but I was unable to find "Concussion due to mildly thrown aerosol can".  What I did find, however, surprised me a bit:
  • Y93.D1 Injury while crocheting and/or knitting
  • W56.22XA Struck by orca
  • W56.11XA Bitten by sea lion
  • V97.33XA Sucked into jet engine
  • X52.XXXA Prolonged stay in weightless environment
  • V95.42XA Forced landing of spacecraft injuring occupant
  • W61.11XA Bitten by macaw, {not to be confused with}
  • W61.12XA Struck by macaw, {not to be confused with}
  • W61.21XA Struck by other psittacines (does anyone other than the ICD-10 authors know what a 'psittacine' is?)
  • W22.02XA Walked into lamppost {which is more of a problem in Narnia, I presume}
  • Z99.89 Dependence on other enabling machines and devices {which I would like to assume means "Addicted to iPhone" but which actually refers to ventilators}
and my personal favourites:
  • R46.1 Bizzare personal appearance
  • V91.07XA Burn due to water skis on fire
These codes are 100% real.  I will repeat: "Forced landing of spacecraft injuring occupant" and "Burn due to water skis on fire" are real diagnosis codes.  For the record, I have used exactly -0- of these in my practice and don't expect to use any of them ever.  Although I will confess that I didn't know R46.1 existed until I wrote this post.  

I may have to start using that one now that I think about it.  It may actually come in handy with my idiots.  I mean patients.

No, I meant idiots.

83 comments:

  1. I've seen a video of W56.22XA. If you search "orca hit trainer" on Youtube, it's the first result.

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  2. So the only way you can hit a lamppost is by walking (searching that site for "lamppost" only shows walking as a way to hit it)? I have nearly witnessed biked into lamppost--a bicyclist was paying more attention to looking at us (Chinese/American couple in China before you started seeing many such couples, and holding hands before such displays of affection were common over there) than where he was going.

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    1. I once walked into one of those iron fence things erected around tree trunks in the city.

      Delete
  3. A psittacine is a parrot. Macaws are also parrots, but I guess they create enough trauma as a genus that they warrant their own code. Unlike passerine birds who have three toes in the front and one in the back, psittacines have two toes in front and two in back. As a veterinarian, we see a lot of interesting trauma cases, and are the source of some as well. I had a ferret bite me badly enough that I had to go visit my doctor for antibiotics and a tetanus booster. I wonder what the code for "Bitten By Ferret" is?

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    1. I have some suggestions for vet codes, I should add ferret infection! I would get a booster but my boss just told us to take the abs from our own pharmacy for free. The tablets were so big though!!

      3067:1 struck in head by wii controller when person not using hand strap
      (Sadly chihuahua had uncontrollable seizures and died not long after admission)
      234:2 ate large amount of river stones and now rattles when walks
      115:6 ate contraceptive products (always used)
      115:7 ate feminine hygiene products (always used)
      003:1 ate toxin - raisins
      003:2 ate toxic vomit of housemate (friends don't let friends get renal failure alone)

      I also find looking through incident logs to see how vet staff have been injured to be fun. There's the usual bitten by cat/dog/bird. But then also -

      Kicked in head by kangaroo
      Bitten by thought to be deceased anima
      Needle stick injury - contaminated with dog urine
      Foreign body in eye - cat claw
      Penetrating injury - sewed self to cadaver whilst closing necropsy

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    2. I particular appreciate your sewing yourself to the animal when closing after a necropsy.

      Good times, good times...

      Wednesday

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    3. My theory (as the owner of a small parrot) for the specific coding is that a macaw bite can do a level of damage a couple steps above the next largest parrot. A parakeet or small parrot (parrotlet, Senegal, lory) bite will sting and may cause bleeding. A medium to large parrot bite (cockatoo, Amazon) can take out a chunk of flesh. A macaw can remove your finger. They are so pretty, though...
      - L

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  4. Hmm. I think Pixar's Syndrome (plus a backstory character whose name I don't remember) had a mild case of V97.33XA

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  5. I come from a family of farmers. I'm sure my stupid uncles have gotten enough injuries from their livestock to justify the codes.

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  6. Is there a code i wonder for blowing high pressure air into the arm?
    My brother did this whilst blowing the dust off himself at the end of a day of work.He hadn't realized that he had knocked the scab off a teeny tiny cut on his arm.The end result was that air went intohis arm. This was particularly funny in that when he and us massaged his arm it crackled. I had a call late at night as i was babysitting bro's sprogs to learn he was now in ER whilst they debated what to do with his arm. scalpels were bandied about and he kept his arm, apparantly 30 mins later he wouldn't have been able to put his right arm in and shake it all about unless they put it in a preserving jar.Personally i have lost count when cleaning out kennels resulting in forgetting to duck when cleaning a particular dog who had had a hernia op and also learned how to climb out his pen resulting in him needing more stitches.
    I had two when the metal rack with little points where the metal had been cut went happily into my scalp scoring my skull.
    I also ended up with a huge bruise to my jaw when i fell off a high chair whilst dusting self same kennels with a very long handled brush and smacked my jaw on the top of the kennel door.
    I also managed to get a massive black eye and a major headache when i was exercising my dogs.WE had an absolutely huge beagle we named Horse, he was almost 3 times the size and weight of a normal beagle.
    Me being me thought it would be fun to teach him to jump.
    My workmate and i set jumps across the doorways of the unit and then she would take him to the end of the unit and i would call him. He would charge down leaping gracefully over the jumps and get his treats. This time he was a wee bit faster than i was expecting and i stopped him with my head, specifically my eye.
    I was rolling around on the floor saying ow, oh dearie me, fending off said dog who was demanding his treats whilst my so called workmate and friend was wetting herself.
    fortunately all i ended up with was a beautiful black eye for several weeks and a headache for a week.
    To date i have not yet tried water skiing, i feel that should i do so
    then i will be the one who ends up with burns.

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  7. Grandma Skeptic21 March 2016 at 23:28

    My youngest child was riding her bike when the neighbor's rooster spurred her back. Chickens, like turkeys, are mean. My son was a teenager, showing off for his girlfriend. He tried to move a trailer full of trash by himself, and wound up with his finger smashed between the hitch and support. His class ring took the brunt of the damage, and saved his finger from being cut off. I fully believe that, at some point in time, all of the stuff in the coding regulations has been claimed.

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    1. I disagree. Look at the V95.4 codes--I don't think most of them have happened. Spacecraft accidents usually involve coroners, not doctors.

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    2. 2007: Three people have been killed in an explosion, during a test of rocket systems to be used in Richard Branson's proposed space tourism ventures.

      Three other people were severely injured in what was described as a major blast at the Mojave Air and Space Port facility in California.

      Delete
  8. .....there are no words. And i thought some of what I've done was obscure and bizarre. Oh it still is, but...THESE? really? they really felt the need to have codes for these? that means that apparently these happened often enough that a code was deemed neccessary. And doc, on the US vs Metric system: think of all the signs, spedometers, tools etc that suddenly would have to be changed across the entire US. Whose gonna pay for it? how much would it cost? yeah. Thats why no metric system in the USA
    Connor

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    1. It's exactly this discrepancy which caused the total loss of the Mars Climate Orbiter.

      https://en.m.wikipedia.org/wiki/Mars_Climate_Orbiter

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    2. I never said the american system is better- its not- just why we haven't changed. Its to expensive/time consuming. Hence why scientists stick with the metric system- to prevent crashes like that from happening again.

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    3. Staying with the imperial system is exactly why it failed and crashed.

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    4. remember that the next time you feel like going to the pub for a pint.

      seriously, let the scientists keep the system where they can set it up to work in multiples of 10. let me keep the system where my measurements all work out to convenient numbers, and I don't have to learn awkward numbers to refer to all my fittings.

      Johnny, pull the fourty-four point fourty-five mm preconnect and douse that fire"

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    5. Hence doc why in NASA measures solely in metric. The rest of the country to transition over would be beyond ridiculously expensive. Metric is better but its just not worth the money to change over.
      Connor

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    6. We still call them pints in metric using countries. For some reason some things are still often spoken about in ye olde imperial. Baby weights, people heights, alcohol servings, piercing jewelry sizes.... some things die hard.

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    7. and for good reason. traditional weights and measures are based on convenient artifacts, while metric is based on the properties of water and the length of the meridian running through Paris. There is very little in common use that easily converts from traditional measurements to metric. and meters are not convenient at all for most day-to-day measurements of size. feet and inches and fractions of an inch are much more convenient for common usage.

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    8. We don't need metric. The excuse is, what about the rest of the world? Well the road between here and Sacramento is not going to be yanked up and exported to Sweden. If the Swedes come here and demand kilometers, I say, go back to Sweden.

      Delete
    9. Dear Doc Bastard. First of all, I have to tell you that (1) I absolutely love the stories - I read your blog all the time - and (2) this is my first time writing a comment. Pardon the formatting and typos.

      That disclaimer out of the way.. WHAT ARE YOU DOING insulting us engineers? It's not us who created all those wacky units, its YOU all.

      The pharmacists with their drams and scruples and grains and ounces and grams. The British with their stones and hands and 20oz pints of beer. The jewelers with their pennyweights, troy ounces, carats and grains. The astrophysicists with their lightyears and parsecs (parsec? really?). The horse people with their furlongs and rods and quarters. The drivers with their mpg and mpL and KpL and their horsepower and their ft-lb of torque. The safety guys with their ppm and ppb and TWA exposure limits. The chemists with their moles and molar mass. The HVAC guys with their BTU's and ton's and SCFH and SCMH. The construction guys with their cubic feet and cubic yards of concrete, their gauges of wires, their piping sizing. Etc. etc. etc. It's an infinite jungle of every unit imaginable out there new and old, nonsensical and systematic. Right? THROUGHOUT the entire World. And to that point, no, the SI system has not been implemented everywhere except the USA. Just ask a Welshman to order beer by the milliliter! See what happens next. And then bill him in Euros. HA. (Yup us engineers design the systems to make that beer in those units for those folks)

      And... you doctors with your 5% saline, and your lactated ringers with its 28mEq of lactate. What the hell is that anyway? Nonsense I say. 28 milliequivalents of lactate is what in terms of milligrams per L of solution? Those are the units I want to see. You all are no better than the rest of us!

      Here's a more serious example. Lab tests just came back showing CEA = 25 (doubled in 1 month) on a particular patient (not me if that's what you're thinking). One nurse said.. "oh that's not very high at all, I have patients in the 250 range". Another (this time an oncologist) said "that's not good". Why the discrepancy? Why is the Doc saying "not good" while the nurse says "no worries?" Why? Because of the UNITS! 25ng/mL vs 250mg/dL. I challenge you to explain the difference. hint: think deci vs deca vs typo.

      Anyway.. We engineers are taught to work with other engineers and their god awful units AND we're taught to work with the rest of you all and your crazy units too. We're not the reason for the Brits drinking "gills" of whiskey, but we do know how to convert. Most of us anyway.

      PS... any engineer responsible for a $328 million dollar spacecraft better damn well check his calcs and verify them with the team he's working with prior to launch. Else... well... we have discussions like this one. :)

      Keep up the great stories. Perhaps I'll post again.

      Delete
    10. If the rest of your comments are anything close to this one, I'd humbly request that you stick around and keep at it. Because you nailed this one dead on.

      Delete
  9. don't you mean others suffering from code ID.10T?

    I've suffered a code W61.11XA. didn't know it was supposed to be recorded anywhere. I've actually also suffered a W61.12XA. and you're right, they are totally different.

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  10. It is apparently important to ask questions and ensure you listen to the answers provided to ensure you properly distinguish between V97.33XA and V97.33XD. Though, my first thought is; how many times can a person be sucked into a jet engine.

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    1. How about:
      V90.24XD: Drowning and submersion due to falling or jumping from burning sailboat, subsequent encounter

      How many times can one person drown? I'm just about prepared to believe that it's possible to be forced to jump from more than one burning sailboat in a single lifetime, but I would have said drowning was very much a one-time-only thing!
      Ugi

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    2. "Subsequent encounter" means a followup visit, not that they jumped from two burning sailboats.

      Delete
    3. That's a shame, because I really like the idea of a life filled with jumping from burning sailboats, but it also doesn't explain some of them, like the above and similar ones like:

      X92.0XXD - assault due to drowning and submersion in a bathtub, subsequent encounter.

      If you're drowned in a bathtub, you're dead. So how come you need a follow-up visit to the doctor? Once you're dead, what more is there to consult on? It's not like you might need your medication reviewed or your progress monitored!

      Ugi

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  11. As a medical coder, thank you for shining a light on what we do all day, every day!

    ...Please pray for us

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    Replies
    1. I've been thinking of becoming a medical coder! But I hear the jobs are hard to get! Is it worth the schooling? thanks!

      Delete
    2. It really depends on the demand in your area. My country has a huge demand overall in everything health related, and I happen to live near a large city with many health offices and hospitals so it was a bit easier for me. Check your local demand for those in medical coding!

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    3. thank you! I will do that!

      Delete
  12. Could someone survive being sucked into a jet engine?

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    Replies
    1. quantify "sucked in" a guy was snatched by a jet on an aircraft carrier, but his helmet lodged in the intake and prevented him actually being ingested.

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    2. It's being sucked *through* that's the problem.

      Delete
  13. My idiot son in law (at the time) thought it'd be funny while shopping in the office supply section to take a can of air with the nozzle for cleaning off keyboards and stick it to my back and spray me with it. Ha ha. Funny. It was cold. AT FIRST. Then I ended up with a freaking 2nd degree burn. That hurt. Bad. No, I never saw the doctor about it, treated it at home and thoroughly never let this son in law live it down.
    Ps. He's still an idiot.

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  14. Hmm. *Browses some of the codes* let's see what we have here...

    Um, Telephone scatologia F65.89 applicable to necrophilia?!

    Yeah, that's enough internet for me today I think. I really don't want to know why they felt that needed to be included.

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  15. Although they serve a purpose, I hate those damned codes. American doctors throw every code imaginable into the paperwork they send to insurance companies. It assures that they will get paid enough to keep the practice going. So, if I go to my doctor for a chest cold he bills for my heart condition and breast cancer and a discussion about depression and substance abuse that we never had and even about a discussion about quitting smoking when I have never smoked. It's absolutely insane. I guess I'll search the codes before I go in next time. Maybe I can find a few that he can keep my insurance company amused with.

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    1. Hi, insurance adjuster here. My favorite is getting the code for neck sprain/strain, followed with each code for cervical, thoracic, and lumbar sprain/strain, followed by cervicalgia...which broken down is cervic (neck) + algia (pain). Neck pain.

      But maybe it's a case of covering all their bases? πŸ˜‚

      Delete
  16. I just stumbled upon your blog, I really appreciate your straight forward, MEDICALLY backed opinions and stories!!

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  17. My bro was drunk and thought it would be a fun idea to squirt aerosol cream up his nose.
    It is not fun, all he smelt for weeks was rancid cream and tasting rancid cream when he ate.
    It is a good job my family has a medical background and classes all our accidents and interesting diseases (fungal infection of the liver which then spread to his eyes - my uncle)as entertainment. I now care for him after he had a happy wander through the medical a-z starting off with uncontrolled diabetes, cellulitis in his whole left arm down to his wrist and inguinal sepsis then a perforated duodenal ulcer which on the removal of the 2nd set of staples promptly unzipped and back to icu, followed by renal failure (now stage 4 with the odd foray to stage 5) 2 tia's the fungal infection, gallstones. peripheral vision in his left eye and a retinal membrane in his right eye, severe neuropathy in hands and feet, congestive heart failure, a nephrostomy in his right kidney and bladder weakness. we are waiting for him to go for the full house.
    The down side is his diet is a pain. he lost 10 stone in 7 months and is now back up to 17 stone from 12 st. 9lb. Most is water weight since he won't stick to his max 2 litres a day
    His diet is low salt low sugar low fat and low potassium.

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  18. I forgot to add he recently also yhad a massive kidney abscess (drain in for 5 weeks, a grossly abnormal right kidney and an undersized left kidney. a stricture in his right ureter as well which they couldn't even get a guide wire up. He will at some point be on dialysis as they will have to remove his right kidney at some point.
    I have told him to ask for it in a jar :)

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  19. We should instigate a competition to find the weirdest/funniest/most ridiculous code, with the Doc' as ultimate arbiter.

    I'll start the bidding at: V00.152S : Heelies colliding with stationary object

    Ugi

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    1. "I'll start the bidding at: V00.152S : Heelies colliding with stationary object"

      That's probably fairly common.

      https://www.youtube.com/watch?v=xUt4k4L0ImI

      Delete
  20. W56.82XA Struck by turtle, initial encounter

    Is turtle-throwing a thing? I mean, turtles aren't exactly known for their speed, so I'm wondering how one finds themselves struck by a turtle unless someone throws a turtle at them

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    1. Turtles can attain considerable speed when accelerated at -9.8m/s^2.

      (In other word, by falling or being dropped, say from a bird of prey.)

      Delete
    2. Would one consider a tortoise to be the same as a turtle for ICD-10 purposes? If so, I now know the official cause of death of Aeschylus!

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    3. I didn't know there are birds of prey that drop turtles. Thanks for that interesting fact!

      Delete
    4. seagulls also drop shellfish to crack the shells; though they usually don't aim for people.

      Delete
  21. Some of these are pretty darn specific! How about:
    08H131Z : Insertion of Radioactive Element into Left Eye, Percutaneous Approach

    Can't see that one getting worn out.
    Ugi

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  22. Lmao!! Invention is born of need. Strange ass needs, I would say!

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  23. This reminds me of that old Porky Pig / Daffy Duck cartoon where Daffy ends up selling Porky an oddly-specific insurance contract that pays out big.

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  24. I work for a car insurance company handling personal injury and liability claims. I hated when the US made the switch from ICD-9 to ICD-10, because ICD-9 was so much simpler to remember the codes. It's a joke in our office about the absurdity of available codes. Too bad I don't get new claims anymore because I got a job in the marketing position and will be switching over soon...I could entertain myself for some time looking for the most absurd codes when updating new claims. (On second thought, maybe it's best for everyone involved that I'm switching from claims to marketing! :P)

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  25. V97.33XA Sucked into jet engine, initial encounter

    Implying there may be a second encounter?

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    1. Here's one case of someone being sucked into a jet engine and surviving. Aircraft carrier crewman, sucked into the jet engine of an A-6. His helmet was pulled off and jammed up the blades.

      Page with safe for work video of the incident, and interview with the lucky crewman:

      http://www.military.com/video/military-aircraft-operations/aviation-accidents/man-swallowed-by-jet-engine/763661791001

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  26. I'm just lowly Admin Asst who's been working in the medical field for a good long time now - I enjoy your blog! Just signed up so I could comment. All I know about ICD-10 is that transitioning from ICD-9 is a royal pain!

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    1. Whatever the reason you signed up, welcome.

      Delete
    2. I've been following the Jahi McMath story, and when I google it, I see a lot of your posts! Very good info - I'm pretty good at digging through medical terminology (have done medical transcription - fun!!!)and after having read reports on her condition, well, I'm pretty much sure that the poor girl is about as gone as a girl can get, and the way you manage to explain things in an easy-to-understand manner is great. Then again, some people just like to involve themselves in discussions they don't seem to understand just so they can show off their ignorance - just wanted everyone to know I'm not one of those! (In other words, I don't flame or troll or generally make a nuisance of myself.) My comments probably won't add a whole lot to anyone's knowledge or understanding, but they'll almost always be polite!

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  27. I will guess about why ICD-10's are being introduced. There is a utopian idea that very specific codes will support retrospective studies. Giant computers will compare everything to everything, finding all correlations.

    However, when we look for correllations, we find them:
    ( http://www.buzzfeed.com/kjh2110/the-10-most-bizarre-correlations )

    And, the resistance has begun.

    ( http://www.kevinmd.com/blog/2014/08/m-worried-icd-10-heres.html )
    === ===
    [edited] I am not worrying about ICD-10. Here’s why.. I suspect I will have to memorize a different set of 20 codes. When I see a patient who got injured in a spacecraft explosion, you better believe I am going to use M79.609, “pain in unspecified limb”, unless my bills stop getting paid. And if they do, I will learn incrementally more codes to barely get by. You will never find me looking up one of 68,000 codes, 50 times a day.

    I’m pretty sure that most providers out there are going to do the same. Doctors who specialize in rotator cuff surgery will have their most common 20 rotator cuff codes memorized, and will look up other codes occasionally as needed. And the epidemiologists and policymakers who count these things will be left with similar quality data to what they have now: nonspecific-in gives nonspecific-out.
    === ===

    The pressure to make up codes for everything comes from the 1950-60's early days of computing. Computer memory was expensive. Designers were pushed to making the data for each customer or case as small as possible. If there were 30 notations, then storing a number from 1-30 is one byte (8 bits), but storing the description might be 20+ bytes.

    Those days are long gone. Computer memory for processing and storage is amazingly cheap. The big cost is for a human to read the notation and know what it means. Codes are now an expensive way to store data which must be assigned and read by people.

    The The WHO (World Health Organization) holds the copyright for the ICD codes. It is making money from this idiocy. People pay the WHO for the right to process ICD codes in software.

    Modern computing would allow the doctor to write a summary describing the case. If the words were non-standard, the standard phrase could be suggested, as when Google does this for searches. These summaries would be both readable and highly standardized, except for the odd cases. Nothing would need codes. Retrospective searches for data would still be possible, and as useless as ever.

    Government mandate has kept medical software in the style of the 1950's.

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    1. in my service we use a 6 place code to categorize all of our runs (a three digit number and a two digit number) to categorize our responses. this allows technical search options, but as you say, it also results in lazy coding. partly, because we sometimes have a code that fits perfectly, and sometimes nothing really describes what we found. the other part is because it is easy to just throw out a standard general code.

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  28. Doc: This is the most boring topic in your blog. I mean c'mon man you're a clinician. This is clerical stuff man. You should be posting gunshot wounds, stabbing, suicide, hanging, electrocution, pericardial windows, bilateral chest tubes, MVA...etc, etc. All that gore stuff. Not coding.

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    1. Clerical stuff is a lot of what I do, so I thought I'd share. I'm sorry this wasn't as fascinating as some other posts, but . . . wait, no I'm not.

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    2. Some people often forget how much of every job consists of paperwork.
      Connor

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    3. you can't even have a poo without doing some paperwork. ;)

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    4. Someone found you from your blog???? I thought you said you were anonymous. Weird. Now your trite comment when you are remotely criticised.

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    5. I think cornboy confused people finding their way here from other places you have been published with his own fruitless attempts to "out" you.

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    6. Ken its that or hes on bath salts again- that seems the only logical explanation for his pure insanity.
      Connor

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    7. no, I've met a guy who used bath salts. it's not that bad.

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    8. Hmm good point. Off his schizophrenia meds then? No wait i know a schizophrenic and even hed say this kids nuts.
      Connor

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  29. I assume NASA's doctors entered X52.XXXA Prolonged stay in weightless environment in relevant forms when examining astronaut Scott Kelly after his year on the ISS.

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  30. Look man. Nobody pays me to read your blog so I thought I'd give you some pointers on how to make them interesting. Thank you man.

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    1. Nobody pays me to write it either. In case you hadn't noticed, I have several hundred other posts, the vast majority of which pertain to exactly what you mentioned. So if you want something that you'd consider more interesting, they're easy to find.

      I haven't had anyone else complain about the boringness of this post, and it seems to have sparked a rather lovely discussion, so take that however you like.

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    2. I've read them all man.

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    3. Yeah, sure, man. What's so lovely about small talks?

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    4. Then I sincerely appreciate it. Unfortunately I have neither the time nor the idiots to write more often thank once a week or so. If a story bores you, you'll just have to wait for the next one.

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  31. Does anyone know why the coding of the causes of trauma/disease/symptom/syndrome instead of the results - i.e. instead of "third degree burn, 10% of body and where on the body" it's gone into "burned with a firestarter lighter while trying to freebase cocaine at an all night rave".

    I mean what is the point of this?!?

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    1. my best guess is they want to categorize as cause, and there are other codes for severity.

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  32. Ken,

    Thanks for the reply. Just caught that Andrew M Garland references this too.

    I don't doubt it's one of the main reasons (the other being creating administrative jobs). However, the results show the stupidity of an impractical solution that weighs down a process for everyone else just so someone who decides to research how many people are struck by turtles will have data at his fingertips.

    I'm not against data collection, and there is a sweet spot for medical coding, but to expect that you can list every occurrence in nature strikes me as highest form of absurdity.

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  33. So whatever happened that made him pass out from the can?

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  34. I'm glad to learn there's code W22 . 02XA. Happened to me more than once, especially as a child (btw decades before iPhones).
    My friends and parents thought it was amusing that I would be so absorbed by my thoughts or a conversation that I ran into lampposts, traffic signs etc... (it did get better when I got glasses at the age of 18 or 19!)
    Code Y 93 . D1 is very interesting, too. I'll be much more careful when I walk around around knitting in the future :D
    Michaela

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