Wednesday, October 7, 2015

Would You Get Crushed by a Snake Twice?

A Green Anaconda - the world's largest nonvenomous snake
I hope not, but if you do, the latest batch of medical codes has you covered.

Medical codes - those crazy numbers that appear on the paperwork from your doctor, letting the insurance people know that you have a 320.8 and a 719.0 for today's visit.

In the United States, we have several systems of medical codes, including the International Classification of Disease, a "standard diagnostic tool for epidemiology, health management and clinical purposes" according to the World Health Organization (WHO).  The WHO and the CDC work together to create revisions to these codes, which began in the late 1890s.  The latest release, ICD-10, has been used on death certificates in the United States since 1999, but it was only last Thursday that doctors' offices and hospital were mandated to use the newest codes in their diagnostic work.

What does this mean to you?  Nothing in the short term (unless you're in medical billing).  But long term, these new codes will help the CDC and WHO track trends such as where antibiotic resistant bacterial show up the most.

But the new codes are kinda funny because they try to account for everything that a person can do to get hurt/injured/infected, including getting crushed by a nonvenomous snake not once, but twice.

Here are some of the unique new codes:

  • Bitten by an orca 
  • Bitten by a shark
  • Crushed by a nonvenomous snake
  • Bitten by a squirrel
  • Burned by water skis that are on fire
  • Spacecraft explosion injury
  • Spacecraft fire injury
  • Unknown spacecraft injury, e.g. a space toilet falling on your head and killing you
  • Bitten by a pig
  • Struck by a pig
  • Poisoning by caffeine, assault
  • Toxic effect of venom of caterpillars, assault
Seriously, how can a caterpillar assault you?

Several of the new codes come with instance modifiers; for example, "Bitten by an orca" comes in  
three varieties:
  • initial encounter, 
  • subsequent encounter, and 
  • sequela.   
Therefore, ICD-10 has three codes for bitten by an orca, depending on how many times you've been bitten.  (This begs the question, who gets bitten by an orca more than once?)

Also, for codes that relate to venom or poisoning, the codes contain modifiers related to cause.  So for "Poisoning by caffeine" has four codes for:
  • accidental (unintentional)
  • intentional, self-harm
  • assault
  • undetermined
Alex Gomez' hand
This past summer, two different men found a rattlesnake and decided to take a selfie with the snake. One, Alex Gomez, picked it up, snapped a shot, then tried to reposition the snake to lay around his neck.  The rattlesnake, having enough photos for the day, bit the man on his thumb.  The other man, Todd Fassler, did the same thing, only he got bitten in his arm and needed all the antivenom available from two hospitals to live.

Truly, I don't blame the snake in either case.

But I wonder, in the new ICD-10, are these incidents classified as accidental, intentional, or assault?  Because no one intented to get bitten, which leans towards accidental.  But both men definitely picked up a rattlesnake, an intentional action.  And the snake intentionally bit them - does this count as assault?

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