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Baffling Deficiency of New ICD-10 Codes | Guest Blog

How is there a code for drowning and submersion due to falling or jumping from burning water-skis but not one for elevator injuries?

Many years in the creation and tens of thousands more codes than ICD-9, yet the new ICD-10 list may be inadequate.

An actor was hospitalized after his foot became caught an elevator raising the stage during a performance of the Broadway show “Spider-Man: Turn Off The Dark.”

As a connoisseur of ICD-10 codes, I decided to see if I could classify this injury correctly.

To my surprise, I could not.

The only codes having to do with elevators are the W303XXs Contact with grain storage elevator.

Since I had once read that the codes were originally developed in Europe, I even searched for “lift.” But all I got were Y93F2 Activity, caregiving, lifting and W240XXs Contact with lifting devices, not elsewhere classified.

Contact with lifting devices, not elsewhere classified hardly seems appropriate for elevators, which are so common. People are frequently hurt on them or by falling down their shafts. All you get when you search “shaft” are hundreds of codes dealing with bones.

We know that ICD-10 has given us such gems as

V982XXA Accident to, on or involving ice yacht, V9542XA Forced landing of spacecraft injuring occupant, V9027XA Drowning and submersion due to falling or jumping from burning water-skis, W5609XA Other contact with dolphin, and V9733XD Sucked into jet engine subsequent encounter.

[Click on the links to read my comments about those codes.]

So how is it that there’s no code for contact with an elevator? For that matter, what about injury during a Broadway show? Surely both elevator and Broadway show injuries are much more common than say V8022XA Occupant of animal-drawn vehicle injured in collision with pedal cycle.

A Twitter follower suggested W230XXA Caught, crushed, jammed, or pinched between moving objects, initial encounter, but it is not clear that there was more than one moving object.

In a year, use of the ICD-10 codes will be mandatory for doctors and hospitals, and the stated aim of ICD-10 is to introduce much more specificity into the codes for better tracking of things like injuries.

Now that I have identified this glaring omission, I am worried that there may be others. What we need is even more codes. Maybe we need to get going on ICD-11 sooner than we thought.

Skeptical Scalpel is a recently retired surgeon and was a surgical department chairman and residency program director for many years. He is board-certified in general surgery and a surgical sub-specialty and has re-certified in both several times. For the last three years, he has been blogging at SkepticalScalpel.blogspot.com and tweeting as @SkepticScalpel. His blog averages over 1000 page views per day, and he has over 7100 followers on Twitter.

  • Karen RN says:

    Reading your blog first thing in the morning starts my day off right. I have a suggestion for an ICD-11 code: indefinite, involuntary confinement for ignorance and a complete lack of capacity for critical thinking. I wanted to use euthanasia, but I decided confinement would raise fewer objections.

  • Hans says:

    Why not combine MESH and ICD-XX and any other coding systems together.

    http://www.nlm.nih.gov/cgi/mesh/2013/MB_cgi?mode=&index=4411&field=all&HM=&II=&PA=&form=&input=

    The point is to add meta data to an event. All coding systems should be available in an EHR. Until the field can work backwards, the actor is insured probably has an ID , the stage is insured, probably had plans submitted, reviewed, and IDed. Having access to these IDs would identify the event. Tag everything.

  • niko says:

    Someone made a picture book illustrating ridiculous ICD-10 codes. Many of these are listed.
    http://www.icd10illustrated.com

  • SkepticalScalpel says:

    I hadn’t thought of that. You might be on to something.

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