ICD-10 is a set of around 70,000 diagnosis codes. ICD stands for International Statistical Classification of Diseases and Related Health Problems. The verbosity of the name is foreshadowing.
Some of the ICD-10 codes are awfully specific, and bizarre.
For example,
- V95.4: Unspecified spacecraft accident injuring occupant
- V97.33XA: Sucked into jet engine, initial encounter
- V97.33XD: Sucked into jet engine, subsequent encounter
As I understand it, V97.33XD refers to a subsequent encounter with a health care professional, not a subsequent encounter with a jet engine. But you have to wonder how many people who have been sucked into a jet engine survive to have one, much less two, medical visits.
There is a specific code, Y92.146, for injuries in a prison swimming pool. It seems strange to combine a medical diagnosis and its location into a single code. Is a swimming injury in a prison pool medically different than a swimming injury in a YMCA pool?
I understand that the circumstance of a diagnosis is not recorded strictly for medical reasons. But while 70,000 is an unwieldy large set of codes, it’s kinda small when it has to account for both malady and circumstance. Surely there are 70,000 circumstances alone that are more common than being in a spacecraft, for instance.
Is there a code for being at the opera? Why yes there is: Y92.253. However, there are no codes that are unique to being at a Costco, Walmart, or Jiffy Lube.
Update: Here’s one I ran across recently. X96.2XXA: Assault by letter bomb, initial encounter.
V97.33XA and V97.33XD have happened on US Navy aircraft carriers. J.D. Bridges is used as an example of how dangerous deck operations are to this day. His survival is an example of an amazingly improbable event that could happen dozens of times a day. The History Channel has a short clip about him and his incident (https://youtu.be/GF3Iz7b95-8).
That’s amazing that someone has survived such an accident. But there must be more common injuries that didn’t make the list of codes.
As someone who worked on the insurance side (automated systems) of this, ICD enumeration has always fascinated me.
As near as I can tell, the reason for the haphazard coverage are the following two facts. (A) It takes an act of Congress (figuratively) to get a new code added & (B) informal, “close enough” codes are used all the time.
Consequently, circumstances have expanded the base set of codes, but in an unplanned, non-uniform manner. And the gaps have never been filled in because similar codes can be used. I saw providers who would consistently miscode in one way or another, and there was an understanding between them and the insurance company about what they really meant.
So many Y92 and W94 codes for incidents happening in the home.
That’s it. Safety demands I move to Costco, Walmart, or Jiffy Lube.
“Is a swimming injury in a prison pool medically different than a swimming injury in a YMCA pool?” – this made me laugh out loud. Well written as usual ;)
That categorization system is crying out for imrpovement.
This reminds me of the rabbit hole I went down a few years ago trying to understand the CPT codes on my medical bill for putting a couple stitches in my chin after a bicycle accident.
https://en.wikipedia.org/wiki/Current_Procedural_Terminology
The bill had a list of codes with prices, but not explanation as to what each one was. The codes are copyrighted by the American Medical Association and access to the their definitions, as I understand it, requires a license. Calling my insurance provider and asking about each code shed some light on them, but they had to speculate. The patient person on the other end of the line could tell that the treated and dressed a “head wound” but nothing much more specific, which made me laugh.
It feels like a very broken system and seems to be a U.S.-only, from what I’ve read. Makes me wonder why it exists and what the advantages are, if any.
Without knowing anything specific about this system, from the listed examples it seems to be constructed by many different people for many different purposes.
Making “spacecraft accident” its own category makes little sense from a statistical perspective (at least at the present time), but might make sense from a medical one, as being in a spacecraft could have effects on a person’s body that other, more common circumstances would not. On the other hand, the “prison swimming pool” category makes little sense from a medical perspective, but more sense to, for example, a statistician studying how dangerous prisons are.
Of course, regardless of your profession it makes more sense to have one list of codes for circumstance and another for malady (and possibly a third for initial/subsequent visits) than to combine them all into one.
“Is a swimming injury in a prison pool medically different than a swimming injury in a YMCA pool?”
Well, that depends. What are the odds of your YMCA pool injury being caused by a well-sharpened toothbrush?
Being injured at a costco would be a Y92.512 “Supermarket, store or market as the place of occurrence of the external cause” which is a subset/evolution of E849.6 “Accidents occurring in public building”
There is a NATO extension of ICD1O, STANAG 2050, which specifically covers military causes of injury, including those relating to military spacecraft and instrumentalities of war. It’s not easy to find.
So Costco has to share a code with Walmart, but opera houses don’t have to share a code with movie theaters.
V91.07XD. Burn due to water skis on fire
X.5119. Prolonged stay in a weightless environment
W56.012. Bitten by dolphin
I find ICD-10 codes fascinating and once wrote a Twitter Bot to post a random one every hour.
https://twitter.com/DailyICD10
The prison pool is probably so it will be billed to the prison. If it was just pool and the patient had insurance it could be accidental billed to their insurance which is not liable for their medical bills while they are in prison or police custody in general.