
Rare and strange ICD-10 codes - zdw
https://www.johndcook.com/blog/2019/04/27/rare-and-strange-icd-10-codes/
======
secstate
These are too funny: [https://www.empr.com/home/features/the-strangest-and-
most-ob...](https://www.empr.com/home/features/the-strangest-and-most-obscure-
icd-10-codes/)

Choice selection:

V91.07X - Burn Due to Water Skis on Fire(?!)

W61.42XA. Struck By Turkey, initial encounter. If a duck is involved, there's
a code for that too. (W61.62X)

R46.1. Bizarre Personal Appearance.

~~~
jhbadger
My favorite: T63.012D: Toxic effect of rattlesnake venom, intentional self-
harm, subsequent encounter

So basically you have a case where someone not only intentionally wanted to
harm themselves with rattlesnake venom once, but at least twice!

~~~
ebg13
> _So basically you have a case where someone not only intentionally wanted to
> harm themselves with rattlesnake venom once, but at least twice!_

No, you misunderstand the terminology. "Subsequent encounter" means with the
doctor not with the rattlesnake. AKA followup care during or after recovery.

~~~
westurner
> _No, you misunderstand the terminology. "Subsequent encounter" means with
> the doctor not with the rattlesnake_

You can reference ICD codes with the schema.org/code property of
schema.org/MedicalEntity and subclasses.
[https://schema.org/docs/meddocs.html](https://schema.org/docs/meddocs.html)

"Subsequent encounter" is poorly defined. IMHO, there should be a code for
this.

~~~
ebg13
> _" Subsequent encounter" is poorly defined._

"Poorly defined" is poorly defined. Explanations of when to use the D make
perfect sense to me.

"The 7th character for “subsequent encounter” is to be used for all encounters
after the patient has received active treatment of the condition and is
receiving routine care for the condition during the healing or recovery phase.
Examples of subsequent encounters include cast change or removal, x-ray to
check healing status of a fracture, removal of external or internal fixation
device, medication adjustments, and other aftercare and follow-up visits
following active treatment of the injury or condition. Encounters for
rehabilitation, such as physical and occupational therapy, are another example
of the use of the “subsequent encounter” 7th character. For aftercare
following an injury, the acute injury code should be assigned with the 7th
character for subsequent encounter."

------
pjungwir
No discussion of strange ICD-10 codes can omit this amazing book:
[https://www.icd10illustrated.com/](https://www.icd10illustrated.com/)

------
leovander
Looking at secstate's post reminds me of one of the neater things (at least to
me) in FHIR models, that a patient can also represent an animal. I have only
worked with HIEs and EHRs for humans so I don't know what veterinarians' EHRs
may be using. Do they use race and ethnicity fields for animal type and breed?

Anyway, my only other IDC related story is that of going from ICD-9 to ICD-10,
when decimals came into play. We had several projects where we had to go back
and do global replaces on ICD-9 codes to play nicely with the ICD-10 codes.

~~~
nwhatt
Animal was removed from the base Patient resource spec in r4.

~~~
leovander
I did see that after I posted last night. It looks like they are now an
extension.

[https://www.hl7.org/fhir/extension-patient-
animal.html](https://www.hl7.org/fhir/extension-patient-animal.html)

------
tyingq
_" V97.33XA: Sucked into jet engine, initial encounter"_

There's a fairly well known incident where a sailor was sucked into the intake
of an A6 Intruder, and lived:
[https://youtu.be/AF55oyAJDBk](https://youtu.be/AF55oyAJDBk)

~~~
johndcook
Not everything that has happened once can have its own code. There must be
things that happen more frequently that don't have their own code.

~~~
tyingq
I wasn't seriously suggesting they should. Just noting it is possible to
survive an "initial encounter". I wouldn't have guessed so had I not seen that
prior.

~~~
jetti
"Initial encounter" means the first time seeing the medical professional and
not the first time the accident happened.

~~~
tyingq
Ahh, thanks...that makes sense. Still holds though. No coding an initial
encounter if your first stop is a coroner.

------
jetti
"Is a swimming injury in a prison pool medically different than a swimming
injury in a YMCA pool?"

They are medically but they will be covered differently by insurance. A
private insurance company would probably not cover a swimming injury in a
prison pool as they would pass that off to the government

------
adolph
As a response to Cook:

[https://www.wearethemighty.com/articles/how-the-luckiest-
sai...](https://www.wearethemighty.com/articles/how-the-luckiest-sailor-on-
earth-survived-being-sucked-into-a-jet-engine)

------
specialist
Every time I nark on ICD-9, -10, -11, someone claims there's some hidden
benefit as yet unrevealed to us mortals. Just clap louder and Tinkerbell will
fly.

Is this true? Even in finely contrived circumstances using the biggest
suspensions of disbelief?

I've looked a few times, have found no studies showing ICD-* improve patient
outcomes, reduce costs, or any other healthcare benefit. (Consultants and
insurers do okay, though.)

When will we learn? This is just another rehash of ontology vs folksonomy,
symbolic vs machine learning AI, data dictionaries vs screen scrapping, etc.

Source: Implemented 5 health exchanges, was active during transition from
ICD-9 to ICD-10.

~~~
noelsusman
The benefits seem pretty obvious to me. I work for a hospital and a few years
ago we discovered that we had a serious problem with sepsis. Every hospital
struggles with sepsis, but our sepsis mortality rates were higher than our
peers. As a result, we invested significant resources into improving how we
handle sepsis, and our mortality rates have gone down.

None of that would have happened if ICD codes didn't exist.

Frankly, ICD codes aren't even there to improve outcomes or reduce costs. They
exist primarily for billing purposes. Anything else we get out of them is a
bonus.

~~~
DoreenMichele
_They exist primarily for billing purposes. Anything else we get out of them
is a bonus._

Yes. If you work in insurance and have the right code, you know you can pay it
without pending the claim and sending a letter requesting additional
information. If you have the medical records but no code, you may have to ask
for additional info to determine if it is covered.

~~~
specialist
I'm still struggling with the notion that an insurer, and not the health care
providers, now determine medical necessity.

~~~
DoreenMichele
You can get a doctor to write a _letter of medical necessity._ Sometimes that
will get it covered.

But, yeah, the US healthcare system has issues.

------
tejtm
Mmmm, love me some ICD code hilarity

Less funny is the human condition reduced to billing codes as only available
option in the age of electronic health records moving towards precision
medicine.

What if clinicians were able to describe what they observed at a granularity
they found appropriate in terms they went to great (and expensive) lengths to
learn?[1]

What if untrained people could describe patients in a way that could be
equally meaningful (if not better informed)?[2]

What if instead of dead ending on an insurance ledger, the codes describing
your medical condition were part and parcel of an extensible logical framework
over which reasoning and inference engines are run (okay fine... call them AI
& ML if you are feeling buzz word deficient)[3]

What if using these alternative codes afforded way of leveraging that science
stuff grad students have been inflicting on little critters since time
immemorial?[4]

Note: Most everything is available on GitHub and work is ongoing ...

1 [[https://hpo.jax.org/app/](https://hpo.jax.org/app/)] 2
[[https://hpo.jax.org/app/help/layperson](https://hpo.jax.org/app/help/layperson)]
3
[[https://en.wikipedia.org/wiki/Ontology_(information_science)](https://en.wikipedia.org/wiki/Ontology_\(information_science\))]
4 [[https://github.com/obophenotype](https://github.com/obophenotype)]

~~~
nradov
ICD is primarily for billing and analytics, but it's not the only option.
SNOMED CT is usually a better fit for clinical use cases.

------
westurner
This parses the ICD 10 CM with lxml:
[https://github.com/westurner/pycd10api/blob/master/pycd10api...](https://github.com/westurner/pycd10api/blob/master/pycd10api/icd/cm.py)

------
Insanity
You might also enjoy this:
[https://twitter.com/EPICEMRparody](https://twitter.com/EPICEMRparody)

------
didgeoridoo
There's a whole book of these:
[https://www.icd10illustrated.com/products/book](https://www.icd10illustrated.com/products/book)

------
wolfi1
ICD-11 will also have codes for TCM, so no end to strange codes

~~~
yorwba
You can already browse the draft here:
[https://icd.who.int/browse11/l-m/en](https://icd.who.int/browse11/l-m/en)

Some examples with interesting names:

SD24 Frequent protrusion of tongue disorder (TM1)
[https://icd.who.int/browse11/l-m/en#/http%3a%2f%2fid.who.int...](https://icd.who.int/browse11/l-m/en#/http%3a%2f%2fid.who.int%2ficd%2fentity%2f1763126515)

SD70 Qi goiter disorder (TM1)
[https://icd.who.int/browse11/l-m/en#/http%3a%2f%2fid.who.int...](https://icd.who.int/browse11/l-m/en#/http%3a%2f%2fid.who.int%2ficd%2fentity%2f738109819)

SE90 Qi deficiency pattern (TM1)
[https://icd.who.int/browse11/l-m/en#/http%3a%2f%2fid.who.int...](https://icd.who.int/browse11/l-m/en#/http%3a%2f%2fid.who.int%2ficd%2fentity%2f1235397351)

SG29 Triple energizer meridian pattern (TM1)
[https://icd.who.int/browse11/l-m/en#/http%3a%2f%2fid.who.int...](https://icd.who.int/browse11/l-m/en#/http%3a%2f%2fid.who.int%2ficd%2fentity%2f1517164035)

