Photograph by frances1972 via Creative Commons
In the Waiting Room
Struck by a macaw? Your new diagnosis code is W6112XA.
At the moment, any accident or malady that befalls you is assigned one of 14,000 codes in the ninth edition of the International Classification of Diseases. After October 1, your doctor will have to thumb through the 70,000-plus codes of the ICD-10.
You'll need to be a patient patient, as healthcare workers struggle to encode, recode, and decode your illness. The government is issuing enough code books to power the French Resistance, and there are quick-start guides, smartphone apps, webinars, clearinghouses to help with claims…
So while you wait for the paperwork, why not distract yourself from your freshly coded malady by perusing the index?
There are real and awful disorders listed that will make you shiver—or turn you into a hypochondriac. Watermelon stomach, woolly hair, corkscrew esophagus, Barcoo disease (or rot)...
Other disorders are interesting because they’re billable: Accentuation of personality traits, Type A, is Z73.1. Amoral traits is F60.89. Sexual aversion is F52.1. Belching can be coded as nervous or psychogenic eructation, F45.8. Hysterical walking, possibly due to a trance or possession disorder? F44.89
And when you add the “activity” codes designed to provide more information about an injury, you come up with some doozies: Y93.D1 is knitting and crocheting, so stabbing yourself with a knitting needle would be Y93.D1. Horseplay and roughhousing is Y93.83—parents might need that one. There’s a code for milking an animal, playing an electronic keyboard, or doing guerilla drills. There are different codes for recreational injuries, depending on whether you’re playing ultimate Frisbee, dodgeball, cricket, or Capture the Flag (the list goes on). There are place codes, too—specific indicators that an injury took place at, say, a slaughterhouse. Or a prairie. Or an opera house.
In a post for PowerYourPractice.com, medical writer Xavier Martinez carried the codes to their ridiculous extreme (which meant he didn’t have far to go) by presenting Awards for the Most Bizarre IDC-10 Codes.
“Bitten by orca, initial encounter” would be W5621XA—an optimistic code, presuming as it does that you will survive that whale bite and (here it turns pessimistic) get bitten by another orca.
And the gold medal in the Water Sports category went to V9107XA: “Burn due to water skis on fire.”
The aspirational code, of course, is X52: “prolonged stay in weightless environment.”
But in all seriousness: This is going to be a frustrating time. Not only are there now 70,000 possible codes, but medical providers must also begin using the newest psychiatric codes (from the fifth edition of the American Psychiatric Association’s Diagnostic Standards Manual).
New disorders in the DSM-V include hoarding, cannabis withdrawal, PMS, excoriation, and disinhibited social engagement. The DSM-V redefined some of the personality disorders (like narcissistic, paranoid, and dependent) but kept others (like borderline, obsessive-compulsive, and antisocial).
Danielle Weekley is the billing manager at Human Support Services, a nonprofit providing behavioral health care in Monroe County. She’s learned the DSM-V and been trained in the new codes, and she’s braced for October 1.
“Obviously, we don’t know all of the effects that ICD-10 will have on the medical world,” she says, noting that it could take longer for patients to get a referral for a test or specialist visit; an authorization for medical services; an appointment; and a bill or an Explanation of Benefits after the service is received.
Too bad there’s no code for Frustration Over Bureaucracy—Healthcare Setting.
