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.
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.
You can reference ICD codes with the schema.org/code property of schema.org/MedicalEntity and subclasses. https://schema.org/docs/meddocs.html
"Subsequent encounter" is poorly defined. IMHO, there should be a code for this.
"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."
This guy has been doing it for 30 years now: https://www.youtube.com/watch?v=AcbqB0pFRPA
And also a longer but older documentary-short about the same person: https://www.youtube.com/watch?v=8q_m-rDUNw0
Edit: Apparently, the same guy (Steve Ludwin) actually has his own snake show on VICE nowadays. You can see all videos about him (and ton of snakes) here: https://video.vice.com/en_uk/topic/steve-ludwin
Operas are so painful to watch there's even a medical code for it.
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.
I like how ICD 9 and 10 don't use mutually disjoint sets of codes so there's a tiny overlap where the same code is present in both but means very different things. But only a tiny overlap so a QA cycle probably won't catch the issue.
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
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
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.
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.
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.
But, yeah, the US healthcare system has issues.
Is that because sepsis diagnosis weren't being captured in the transcribed notes?
Is this kinda related to the checklist manifestos, a la Atul Gawanda?
Hospitals aren't flush with a lot of spare cash, so if doing this required a bunch of complicated text processing then it probably wouldn't have happened, and trying to compare our notes to notes from other institutions just multiplies the nightmare. With ICD codes we all speak the same language.
I other fields of endeavor, when I see such voluminous, nuanced classification codes, the real result is that it becomes confusing as to 1) what code any given subject should be classified as, 2) the people doing the classification cannot know all the codes available and therefore will classify to something close that they know... even if a closer code exists, 3) there can be general disagreement on what any given code means and where dividing lines sit between similar codes, and 4) in medical offices, where several codes may be available and could reasonably apply, I've seen choices made based on the financial differences between the codes where they existed (not to mention that all the previous problems in coding a condition for the practitioner is also a problem for those deciding how codes may/may not be covered or paid for).
Given all that, it seems to me any coding system like this, which apparently fails to account for the limits of human judgement and usage patterns, will ultimately fail. Naturally, I assume that the goal in constructing such a system is the collection of nuanced data, but expect the result to be a muddle of that data as the system is misused.
And based on the medical offices I have worked with over the years, there is nothing about the medical profession that will mitigate those issues.
I expect their to be limits on the effectiveness of that sort of thing. My original comment dealt with the complexity issue, but there's how well that training/certification ages over time... such that common codes are handled well due to daily reinforcement, but less common codes will tend to fare worse. Unless there are required maintenance trainings and re-certification requirements (I'm not aware of that either way), I expect on average for there to be issues in practice.
While there has been medical procedure coding of some sort for a very long time, this rather more complex coding that we're generally discussing with this story is still in rather early days. Nonetheless, I would be interested to see an actual study on how the complexity of coding systems like ICD fare at actually capturing the information they try to; I just tried searching the ACM Digital Library, but didn't find anything... though that could just be weakness of my search terms.
Certified medical coders are required to complete several hours of additional training every year in order to maintain their status.
ICD-9 had been in use for many years. ICD-10 is only slightly more complex. Most provider organizations typically only use a small subset of the available codes so it's not too hard to keep track of the common ones.
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?
What if untrained people could describe patients in a way that could be equally
meaningful (if not better informed)?
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)
What if using these alternative codes afforded way of leveraging that science stuff
grad students have been inflicting on little critters since time immemorial?
Note: Most everything is available on GitHub and work is ongoing ...
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...
SD70 Qi goiter disorder (TM1) https://icd.who.int/browse11/l-m/en#/http%3a%2f%2fid.who.int...
SE90 Qi deficiency pattern (TM1) https://icd.who.int/browse11/l-m/en#/http%3a%2f%2fid.who.int...
SG29 Triple energizer meridian pattern (TM1) https://icd.who.int/browse11/l-m/en#/http%3a%2f%2fid.who.int...