A Code for What Ails You



  • @WSJ said:

    Today, hospitals and doctors use a system of about 18,000 codes to describe medical services in bills they send to insurers. A new federally-mandated version will expand the number to around 140,000, adding codes that can describe precisely what bone was broken and where the patient got hurt, from art galleries to chicken coops.

    TFA has a search widget. Follow that link, and you'll see the diagnosis codes related to turtles:

    • W5921XA by turtle, initial encounter
    • W5921XD Bitten by turtle, subsequent encounter
    • W5921XS Bitten by turtle, sequela
    • W5922XA Struck by turtle, initial encounter
    • W5922XD Struck by turtle, subsequent encounter
    • W5922XS Struck by turtle, sequela
    • W5929XA Other contact with turtle, initial encounter
    • W5929XD Other contact with turtle, subsequent encounter
    • W5929XS Other contact with turtle, sequela

    This makes those silly Unicode glyphs look practically reasonable.



  • To be fair, that's intial and subsequent encounters with the doctor, not the turtle.

     But how do you get struck by a turtle?  Who's going around throwing turtles?



  • @boomzilla said:

    W5922XD
    Struck by turtle, subsequent encounter

    Damm random encounters.

    Edit: code R461 is my favorite so far.



  • I like the ones for lawn: 

    W28XXXA Contact with powered lawn mower, initial encounter
    W28XXXD Contact with powered lawn mower, subsequent encounter
    W28XXXS Contact with powered lawn mower, sequela

    but yet there are none for a thrown lawn mower :S



  • @ijij said:

    But how do you get struck by a turtle? Who's going around throwing turtles?

    Mutated teenaged martial arts enthusiasts, presumably.




  • Not neccesarily related, but still a WTF: in the Netherlands something called "DBC" (Diagnosis-Treament-Combination) was introduced ~3 years ago which acts similar to this. A doctor gets about the same per completed DBC (it differs only by about a factor 10)..

    This has caused supporting professionals like radiologist or anesthesiologist to earn more than €500.000 with a low-volume practice. It also makes it nearly impossible for hospitals to get money for patients who are never really cured, like in mental health care or chronic ailments (cancer, rheumatics, AIDS etc.)



  • The real scary thing is the bureaucracy that manages the reimbursement for those codes. I had a class on medical coding once (although I barely remember any of it and skipped half the classes.. I think I dropped it before the final) and the whole thing is a clusterfuck. Increasing the number of codes by an order of magnitude probably isn't going to help things.



  • @Renan said:

    Edit: code R461 is my favorite so far.

    What is it? It's probably a PEBKAC problem, but I can't seem to search by code



  • @morbiuswilters said:

    The real scary thing is the bureaucracy that manages the reimbursement for those codes. I had a class on medical coding once (although I barely remember any of it and skipped half the classes.. I think I dropped it before the final) and the whole thing is a clusterfuck. Increasing the number of codes by an order of magnitude probably isn't going to help things.

    As long as the problem stays in P I'm not worried.



  • @morbiuswilters said:

    The real scary thing is the bureaucracy that manages the reimbursement for those codes. I had a class on medical coding once (although I barely remember any of it and skipped half the classes.. I think I dropped it before the final) and the whole thing is a clusterfuck. Increasing the number of codes by an order of magnitude probably isn't going to help things.

    I did this for a living around 1996-7. The worst part was trying to read the doctors' handwriting. The coding actually wasn't too difficult, though I had an early computer program with all of the codes that made it fairly easy to search for stuff. If I had to use just the books, it would have sucked. There were certain pitfalls that you had to avoid, like certain procedure codes that you couldn't bill together (because the "bigger" one basically included the other one).

    Then again, it was a fairly focused practice, and the chance of encountering turtles was pretty much nonexistent. These new codes should make for some fascinating data mining opportunities.



  • @dtech said:

    What is it? It's probably a PEBKAC problem, but I can't seem to search by code


    You clearly need to do more Y93C1.



  • @boomzilla said:

    I did this for a living around 1996-7. The worst part was trying to read the doctors' handwriting. The coding actually wasn't too difficult, though I had an early computer program with all of the codes that made it fairly easy to search for stuff. If I had to use just the books, it would have sucked. There were certain pitfalls that you had to avoid, like certain procedure codes that you couldn't bill together (because the "bigger" one basically included the other one).

    Then again, it was a fairly focused practice, and the chance of encountering turtles was pretty much nonexistent. These new codes should make for some fascinating data mining opportunities.

    It wasn't difficult so much as bizarre. I really don't remember why I thought that, though.



  • @dtech said:

    @Renan said:
    Edit: code R461 is my favorite so far.

    What is it? It's probably a PEBKAC problem, but I can't seem to search by code

    Bizarre personal appearance.



  • @ijij said:

    But how do you get struck by a turtle? Who's going around throwing turtles?

    My dogs.

    From 2008 to 2011, I lived in a house that abutted wetlands. Every spring, we'd have turtles wandering through our yard. Nobody went near the snappers (nasty-looking giant beasts that they were), but my dogs thought the painted turtles were wonderful toys.



  • @ijij said:

     But how do you get struck by a turtle?

    I used to play KoL, and this was one of my favorite skills, from my favorite class.

    The damage done by the headbutt is increased if you're wearing any kind of turtle as a helmet.


  • Burn due to water-skis on fire, initial encounter

    ...but how would...water isn't flammable...what the fu...

    Seriously, if you get burned by having your fucking W-A-T-E-R skis on fire, then your life deserves to be claimed by Darwin's law...



  • @C-Octothorpe said:

    Burn due to water-skis on fire, initial encounter

    ...but how would...water isn't flammable...what the fu...

    Seriously, if you get burned by having your fucking W-A-T-E-R skis on fire, then your life deserves to be claimed by Darwin's law...

    Well what if they were being towed down the street on water skis behind a pickup truck? Now I hear you saying, "Who in their right mind would do that?" Exactly the kind of person who would end up in the hospital after being injured by burning water skis, that's who.



  • @Buffalo said:

    @C-Octothorpe said:

    Burn due to water-skis on fire, initial encounter

    ...but how would...water isn't flammable...what the fu...

    Seriously, if you get burned by having your fucking W-A-T-E-R skis on fire, then your life deserves to be claimed by Darwin's law...

    Well what if they were being towed down the street on water skis behind a pickup truck? Now I hear you saying, "Who in their right mind would do that?" Exactly the kind of person who would end up in the hospital after being injured by burning water skis, that's who.

     

    If you ask me that's the type of stuff that SHOULDN'T be covered by insurance anyway. Insurance is there to protect you from accidents and unforseen circumstances, not to protect you from your own blatant intentional stupidity.

    That said, I have a pickup truck. I wonder if I know anyone with water skis...

     



  • @mott555 said:

    That said, I have a pickup truck. I wonder if I know anyone with water skis...

    Sure I do!  As long as I'm the one driving this will be hilarious!

    But aside from that, couldn't they just claim stupidity as a pre-existing condition and deny you anyway?



  • @KattMan said:

    @mott555 said:
    That said, I have a pickup truck. I wonder if I know anyone with water skis...

    Sure I do!  As long as I'm the one driving this will be hilarious!

    But aside from that, couldn't they just claim stupidity as a pre-existing condition and deny you anyway?

    There does not appear to be any codes containing 'stupid' or 'idiot'.  So I guess you can't code that.  I have done other types of coding like Occupation those can get very troublesome very quickly.  The worst two to try and code were 'Teacher' and 'Engineer'.



  • OMG, this is amazing. They really cover everything! I mean, Han Solo could visit the doctor now:

    V9545XA Spacecraft explosion injuring occupant, initial encounter.

    X025XXA Jump from burning building or structure in controlled fire, initial encounter

    W902XXA Exposure to laser radiation, initial encounter

     



  • @TGV said:

    X025XXA Jump from burning building or structure in controlled fire, initial encounter

    If the fire was controlled, why would you jump from the building?

    Fireman: "Ok folks, danger's over, we've put out the fire on all floors, you can now use the stairway to exit, the medics can check you out in the lobby."
    Office worker: "My insurance fraud failed!" *jumps out window*



  • @blakeyrat said:

    @TGV said:
    X025XXA Jump from burning building or structure in controlled fire, initial encounter

    If the fire was controlled, why would you jump from the building?

    Fireman: "Ok folks, danger's over, we've put out the fire on all floors, you can now use the stairway to exit, the medics can check you out in the lobby."
    Office worker: "My insurance fraud failed!" *jumps out window*

    By "controlled fire" I think they mean a fire set intentionally to accomplish a task, not an accidental fire that is under control. My guess is this applies to firemen who are injured when a controlled fire is set to a building for a training exercise.



  • @ijij said:

    But how do you get struck by a turtle?  Who's going around throwing turtles?
     

    Eagles, it seems.  Look up the Greek playwright Aeschylus and the circumstances of his death.  We'll wait.


  • Discourse touched me in a no-no place

    G4482
    Headache associated with sexual activity
     
    You can bill insurance companies for that!?
     
     
    Z7251
    High risk heterosexual behavior
    Z7252
    High risk homosexual behavior
    Z7253
    High risk bisexual behavior
    Wait, what now? Now you're just being fucking silly. That's not a medical diagnosis, that's living it up!



  • @blakeyrat said:

    Office worker: "My insurance fraud failed!" jumps out window

    For some reason I read that in the voice of the lackey from Star Fox 64 who piloted the mech that was the first boss of the game, and said "My emperor! I've failed you!" when he was defeated...



  • Yes, there's a code for a paper cut!

    W451XXA
    Paper entering through skin, initial encounter

     



  • @ekolis said:

    For some reason I read that in the voice of the lackey from Star Fox 64 who piloted the mech that was the first boss of the game, and said "My emperor! I've failed you!" when he was defeated...
     

     W92456XA: Reads forum posts in voice of character from 25-year-old video game, initial encounter

     

     



  • @Weng said:

    Z7251
    High risk heterosexual behavior
    Z7252
    High risk homosexual behavior
    Z7253
    High risk bisexual behavior
    Wait, what now? Now you're just being fucking silly. That's not a medical diagnosis, that's living it up!

    It's also kind of nuts to have three different codes for that. I mean, is that even legal? It seems like grounds for a discrimination lawsuit..



  • @morbiuswilters said:

    I mean, is that even legal? It seems like grounds for a discrimination lawsuit..

    It is probably categorising the event that caused the injury, rather than the sexuality of those involved.

    Which is stupid, since rectal tearing from [hetro|homo|bi]sexual activity is still the same injury, irrespective of the leanings of those involved.



  • @Cassidy said:

    @morbiuswilters said:

    I mean, is that even legal? It seems like grounds for a discrimination lawsuit..

    It is probably categorising the event that caused the injury, rather than the sexuality of those involved.

    Which is stupid, since rectal tearing from [hetro|homo|bi]sexual activity is still the same injury, irrespective of the leanings of those involved.

     

    One of the purposes for this sort of coding is the compilation of public-health data, so that patterns can be tracked and programs can be devised to address widespread problems. So it would be useful to know this in order, for example, for charities to be able to target public service announcements at different populations based on their behavior patterns.

     



  • I understand that reasoning, but it does open up the possibility of lumping together things that have nothing to do with sex simply because of the orientation of the injured person.

    "This guy who walked into the lamppost and bruised his forehead, was he straight or gay?  I need to know for the public health report."



  •  On the assumption that such a distinction actually occurs (while I [i]have[/i] worked on software for this I didn't explore much beyond "injuries sustained during an alien abduction"), that wouldn't "lump together things having nothing to do with sex", but the exact opposite. Later, you could use the same datasets for surveys of both "objects pedestrians collide with" and "relative clumsiness of people with different sexual orientations".

     Incidentally, this "new" system has been around for several years, and has been pretty much standardised worldwide for the very purpose cited by barfoo (it allows comparison of public health data between, say, France and Malaysia without confusion). The only holdout (until the federal government got fed up with the comparatively poor resolution of its datasets) has been the United States, because of its disorganised health system and the fact that it's pretty much only in the United States where its primary use is for insurance billing purposes. Oddly, it's [i]because[/i] of the pedantic dickweedery of the health insurance companies that so many of the piffling fine distinctions are made.



  • @Weng said:

    Z7251
    High risk heterosexual behavior
    Z7252
    High risk homosexual behavior
    Z7253
    High risk bisexual behavior

     

    The third one's great. "We're sorry sir, we can't tell if it's Z7253 until we know who else was in the room with you, and what that person was doing at the time you were injured." 

    Does being shot by your wife's boyfriend count as Z7251 ?

     



  • @AndyCanfield said:

    Does being shot by your wife's boyfriend count as Z7251 ?

     

    Only if he's not also your boyfriend, eliminating Z7253.



  • So, we’re all clear that “subsequent encounter” means a second visit to the doctor?

    What’s “Drowning and submersion due to falling or jumping from burning water-skis, subsequent encounter” then? Did the victim drown, or didn’t they? Or is this subsequent encounter one with the undertaker?



  • You can survive a drowning. I always thought drowning meant inhalation of water, but not necessarily dying from inhaling water.



  • @Watson said:

     On the assumption that such a distinction actually occurs (while I have worked on software for this I didn't explore much beyond "injuries sustained during an alien abduction"), that wouldn't "lump together things having nothing to do with sex", but the exact opposite. Later, you could use the same datasets for surveys of both "objects pedestrians collide with" and "relative clumsiness of people with different sexual orientations".

     Incidentally, this "new" system has been around for several years, and has been pretty much standardised worldwide for the very purpose cited by barfoo (it allows comparison of public health data between, say, France and Malaysia without confusion). The only holdout (until the federal government got fed up with the comparatively poor resolution of its datasets) has been the United States, because of its disorganised health system and the fact that it's pretty much only in the United States where its primary use is for insurance billing purposes. Oddly, it's because of the pedantic dickweedery of the health insurance companies that so many of the piffling fine distinctions are made.

     

     I also work in a hospital, and we do use the ICD-10AM 6th Edition (the one being mandated).  However, because we don't use it for insurance billing, our code-set is around a tenth the size of the US edition - we only have some 16,000 codes - mostly just to cover specific accident sites so we don't have to use (shudder) SNOMED.

     



  • @mott555 said:

    You can survive a drowning. I always thought drowning meant inhalation of water, but not necessarily dying from inhaling water.

    I'm pretty sure drowning always means dying.



  • I can't find the code for trouser-related injuries. I've looked under trousers, pants, and zip, but nothing. And yet this is a serious issue. If 530 Brits need treatment for trouser-related injuries in a year, you can extrapolate to ~2500 US Americans per year suffering similar accidents.



  • @morbiuswilters said:

    @mott555 said:

    You can survive a drowning. I always thought drowning meant inhalation of water, but not necessarily dying from inhaling water.

    I'm pretty sure drowning always means dying.

    what if you get resuscitated by a big-tited blonde from baywatch



  • @Nelle said:

    what if you get resuscitated by a big-tited blonde from baywatch

    Then you didn't drown.



  • @pjt33 said:

    ~2500 US Americans per year suffering similar accidents.
     

    That's 7 people per day.

    Think about it.

    Before you sit down for lunch, three people have already hurt themselves with pants.



  • @dhromed said:

    @pjt33 said:
    ~2500 US Americans per year suffering similar accidents.

    That's 7 people per day.

    Think about it.

    Before you sit down for lunch, three people have already hurt themselves with pants.

    The obvious solution is to ban pants.



  • @mott555 said:

    @dhromed said:
    @pjt33 said:
    ~2500 US Americans per year suffering similar accidents.

    That's 7 people per day.

    Think about it.

    Before you sit down for lunch, three people have already hurt themselves with pants.

    The obvious solution is to ban pants.

    I don't think you have thought this through...



  • @ijij said:

    But how do you get struck by a turtle?

    My first thought was [url="http://www.youtube.com/watch?v=8Yy7iGFVcSA"]this video[/url] at 0:19.



  • @Daniel Beardsmore said:

    @Nelle said:
    what if you get resuscitated by a big-tited blonde from baywatch

    Then you didn't drown.

    Not in water, anyway (although the correct term for what I'm thinking is "smothered").

    @C-Octothorpe said:

    @mott555 said:

    The obvious solution is to ban pants.

    I don't think you have thought this through...

    ... or his work colleagues are much better-looking than yours, obv.

     



  • @pjt33 said:

    I can't find the code for trouser-related injuries. I've looked under trousers, pants, and zip, but nothing. And yet this is a serious issue. If 530 Brits need treatment for trouser-related injuries in a year, you can extrapolate to ~2500 US Americans per year suffering similar accidents.
     

    That's because you're not looking at it from a diagnostic perspective (the [i]trousers[/i] aren't the subject...): what you're alluding to is covered by S3121XA or maybe S30872A.

     



  • @Watson said:

    That's because you're not looking at it from a diagnostic perspective (the trousers aren't the subject...): what you're alluding to is covered by S3121XA or maybe S30872A.

    @S3121XA said:

    Laceration without foreign body of penis, initial encounter

    Remind me that I need to stop using razor wire for trousers.



  • @Daniel Beardsmore said:

    So, we’re all clear that “subsequent encounter” means a second visit to the doctor?

     

    Or does it mean being examined by a second medical professional (not necessarily for a different event)?

     

     


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