“Bitten by an alligator” & other wacky medical codes

Who comes up with this stuff?

As a writer who specializes in health and medicine, I’ve learned about some pretty unusual medical conditions. But the new International Classification of Diseases, Tenth Edition, Clinical Modification—affectionately known as ICD-10-CM—takes it to a ridiculous new level.

The ICD-10-CM is a system that assigns a unique code to all the various health conditions that befall us humans. The original intent of the diagnosis codes was for epidemiological tracking of diseases. Doctors, hospitals and health insurance companies now use them to specify a diagnosis, bill for services and calculate reimbursement.

But get this: the ICD-10-CM, which went into effect October 1, 2015, has over 68,000 codes (compared to 13,000 in ICD-9-CM, which had been in use since 1979). Yes, the folks at the World Health Organization (the group that develops the ICD classification system) sat down and came up with five times as many maladies for which we seek medical treatment. Among them:

• Myriad codes for being pecked, struck, bitten, kicked or crushed by a veritable menagerie, including chickens, turtles, alligators, crocodiles, ducks, sea lions, pigs, cows, macaws and orcas. There are individual codes for an initial encounter as well as subsequent encounters, begging the question, “WTF are you doing to get struck by a duck, or crushed by an alligator, more than once? Do you not know the definition of insanity?”
• There’s also a code for “other contact” with all these animals. Besides being pecked, struck, bitten, kicked or crushed, what other kind of contact would require a doctor or hospital visit?
• No fewer than 25 codes relating to spacecraft occurrences, such as forced landing of spacecraft injuring occupant, spacecraft fire injuring occupant, and spacecraft collision injuring occupant—both initial and subsequent encounters. There’s also a code for prolonged stay in a weightless environment. Houston, we have a problem.
• Codes relating to injuries that occur in specific places, such as the library, the swimming pool or day spa of a prison (crime pays, huh?), the bathroom of a prison (um, no comment), an art gallery, an opera house, a squash court, the bathroom of a mobile home, or the bathroom of a reform school. Why does it matter where the bathroom is?
• Codes for injuries sustained while sewing, ironing, and knitting and crocheting (including an individual code for being stabbed while crocheting). Those crochet hooks can be so aggressive.
• In the on-the-water category, there’s a code for sustaining a burn due to water skis being on fire. How in hell do water skis burst into flames?
• There are codes for being hurt walking into a lamppost, both initial and subsequent encounter. Given the number of people who can’t stop texting while walking, I get this.
• Being sucked into a jet engine, both initial and subsequent encounter. Seriously, someone would—or could—do this more than once?
• Toxic effect of venom of bees, intentional self-harm. This takes the concept of “Bite me” a bit too far.
• Family upbringing issues also have codes. For example, there’s one for sibling rivalry, and one for parental overprotection. Hmm…is there an age limit on these?
• There’s also one for problems in relationship with in-laws, and one for disappearance and death of family member. I wonder if these conditions ever overlap…
• There are codes for bizarre personal appearance, very low level of personal hygiene, and inadequate social skills. Hell, that’s me on day three of the flu.
• Speaking of a low level of personal hygiene, there’s a code for fecal smearing, and (I kid you not) vomiting of fecal matter. Eww. Encounters of the turd kind?
• And perhaps the most compelling code of all: Unspecified event, undetermined intent. What’s the treatment for that?

So what’s all this got to do with being a boomer? Well, it just makes me think of that old Kotex tampon ad with the headline, “Remember how simple life used to be?” Once upon a time, we simply went to the doctor—or the doctor made a house call (!)—and we (well, our parents) received an easy-to-understand bill for services rendered.

With the rise of the medical industrial complex and for-profit medicine, however, it’s a whole new world today. Yes, the new codes aim to make it easier for insurers, including Medicare, to measure outcomes and care quality—factors used to calculate how much to pay doctors and hospitals. And epidemiologists can use these more precise codes to better identify disease outbreaks and public health needs.

But they’ve also spawned an entirely new industry of coding and health data management—another layer of cost and complexity within healthcare. And it forces doctors to spend more of their already-limited patient time documenting all this information—because if they code wrong, they don’t get paid. You know how your doctor seldom makes eye contact with you during an office visit because he/she’s too busy entering your responses into a computer? This is why.

It’s the price of progress, I guess. And there’s this: at least you know that no matter how many times you’re pecked by a chicken, walk into a lamp post or take sick while watching Aida, there’s a code for that.

I feel better already, don’t you?

I’m sick of nonsense.
What’s the ICD-10 code
for that, I wonder?

What do you think of the whole medical coding system? Any other thoughts about healthcare today? Please share!