
Death by Flaming Water Ski, and Other Misfortunes - benbreen
http://www.newyorker.com/tech/elements/death-by-flaming-water-ski-and-other-misfortunes-in-the-international-classification-of-diseases
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showerst
Don't these come from some kind of base grammar? I'd assume they'd just have
something like:

10\. - Bitten By

11\. - Struck By

..and

a12 - Orca

b36 - Macaw

So 11.a12 'struck by orca' would just be a funny consequence of having a large
dictionary, not a sign that the codes were really inflated.

~~~
Sanddancer
Pretty much. There's a syntax and grammar to the syllables involved that leads
to the ones that will probably never happen, but are still amusing to read.
With its layout, you can determine what the injury is, if it was intentional,
how many times the person was injured, etc. It's a pretty dense, nicely
designed coding format that some people just don't understand.

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chris_wot
So apparently Rand Paul said "I’ve asked physicians all over the country: Have
you ever seen an injury from a macaw?"

What a myopic and short-sighted way of viewing the world. I note, with
interest, that he never said "I've asked physicians all over the country: Have
you ever seen a child with Abderhalden Kaufmann Lignac syndrome?".

I suppose that in his quest for "small government" he will shut down the
Genetic and Rare Diseases (GARD) Information Center. [1] After all, most
physicians won't have to deal with many of these diseases in their lifetime.

I'm telling you, it's Obamacare run amok!

1\. [https://rarediseases.info.nih.gov](https://rarediseases.info.nih.gov)

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jessaustin
Presumably the "burning water-skis" cited refer instead to burning personal
watercraft, also known by the trade name of "Jet Ski". A water ski is a wooden
or plastic board that is mostly submerged in water while in use, making it
quite difficult to burn. The whole ICD exercise seems to be about the accurate
use of the English language, so this error does not inspire confidence.

~~~
Sanddancer
It's water skis. V90 is Drowning/Submersion, .2 says that the craft was on
fire, 7 says it's water skis, X is there because there's no need for further
description, and A is the first occurrence. If you look through the whole list
of drowning incidents, you see they all follow the same pattern.

[http://www.icd10data.com/ICD10CM/Codes/V00-Y99/V90-V94/V90-](http://www.icd10data.com/ICD10CM/Codes/V00-Y99/V90-V94/V90-)

~~~
jessaustin
OK you've convinced me; this makes no sense. Where is V90.07?

~~~
Sanddancer
I don't know. This was just a website I found that seemed to have a fairly
complete listing, such as someone being repeatedly beaten with a portuguese
man-o-war [1]. Some of these are rather ridiculous, but it is well categorized
and thorough ridiculousness. Either that, or someone /has/ been beaten with a
rather deadly critter, which sounds more like the plot element of a comedy
horror film than anything.

[1]
[http://www.icd10data.com/ICD10CM/Codes/S00-T88/T51-T65/T63/T...](http://www.icd10data.com/ICD10CM/Codes/S00-T88/T51-T65/T63/T63.6-/T63.613S)

~~~
jessaustin
What I meant was that apparently they have enough editorial oversight to
realize that it's silly to talk about water skis "overturning". However their
editorial judgement apparently does not encompass the impossibility of water
skis burning.

~~~
DanBC
Have you checked the ICD10 entry for burning waterskis? Specifically: Do the
skis have to also be in the water?

[http://www.icd10data.com/ICD10CM/Codes/V00-Y99/V90-V94/V91-/...](http://www.icd10data.com/ICD10CM/Codes/V00-Y99/V90-V94/V91-/V91.07XA)

~~~
jessaustin
You're using a different code! b^) Of course one might suffer burns due to
contact with burning material. (Although in that case, why call out water skis
but not e.g. coffee tables, which also might burn?) Upthread, however, we were
talking about _drowning_ due to burning water skis. That would indicate skis
in use in water.

The whole problem stems from classifying water skis as transportation, which
they are not. Like wakeboards, kneeboards, towable tubes, etc. they are
recreational equipment used in conjunction with powered watercraft, which
_are_ transportation.

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Splines
I'm not at all an expert in this area, but it seems like the codes are poorly
designed.

Changing them to be less descriptive, and allowing for more codes to be
applied to a single case would be more efficient. "Bitten by" and "Orca"
should be two different entities applied to the same case, and together they
describe the incident.

Although given that these codes are probably used in hundreds of thousands of
systems, changing their fundamental structure is probably nearly impossible.

~~~
Sanddancer
That's exactly how the codes are designed. Categories, sub-categories, etc to
describe what caused it, what damage it did, and how many times it did it. For
example, let's take an example of an "Angel of Death" situation, where a nurse
has been repeatedly overdosing a patient with morphine in order to try to kill
them. You're going to want to discuss all of the details of what went on, so
you choose T41.1X3S [1], which is Poisoning, or other effects from
anesthetics. First you look up where poisoning is, T41. Then you look up the
code for anesthetics, which is 1X. It's intentional, so that's class 3. From
there, you can describe each incident, A for the first, D for the second, and
S for any incidents after that. If you look at other areas, like an insect
bite, you'd do similar, and some up with S80.262A [2].

Standardizing the format for the codes is really useful, because it can give
precise instructions as to what happened. But, you can quickly figure out what
happened byt the first code, with the code after the decimal point giving the
exact details, if needed. Yes, it allows for ridiculous combinations, but any
decently designed charting system has similar. Medicare, for example, has
beneficiary codes extending to Second disabled surviving divorced husband [3].

[1]
[http://www.icd10data.com/ICD10CM/Codes/S00-T88/T36-T50/T41-/...](http://www.icd10data.com/ICD10CM/Codes/S00-T88/T36-T50/T41-/T41.1X3S)
[2]
[http://www.icd10data.com/ICD10CM/Codes/S00-T88/S80-S89/S80-/...](http://www.icd10data.com/ICD10CM/Codes/S00-T88/S80-S89/S80-/S80.262A)
[3]
[http://www.ncdoi.com/_Publications/Beneficiary%20Identificat...](http://www.ncdoi.com/_Publications/Beneficiary%20Identification%20Codes_SNE1.pdf)

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protomyth
So, to bill for Medicare and Medicaid services you need to use ICD (
[https://www.cms.gov/Medicare/Coding/ICD10/ProviderResources....](https://www.cms.gov/Medicare/Coding/ICD10/ProviderResources.html)
). ICD-10 is effective October 1, 2015. Here is the quick start pdf
[https://www.cms.gov/Medicare/Coding/ICD10/Downloads/ICD10Qui...](https://www.cms.gov/Medicare/Coding/ICD10/Downloads/ICD10QuickStartGuide20151001.pdf)

