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“That’s the first time I’ve seen that diagnosis!”
I looked up at the electronic chart the resident had loaded on our workroom monitor. Sure enough, the patient’s problem list included ICD-10 code V95.43XS: “Spacecraft collision injuring occupant, sequela.”
“He’s an astronaut?” I asked, hopefully.
“No, I don’t think so” the resident responded, “he appears homeless. And high.”
I was disappointed, my hopes that we had admitted a space traveler to our service overnight were dashed. Instead, the diagnosis was clearly a case of clerical error, a byproduct of a cumbersome and onerous diagnosis system forced upon healthcare providers.
For a hospital or physician to bill for services, the Center for Medicare and Medicaid Services (CMS) requires both a diagnosis and a procedure. These are both assigned alphanumeric codes: Diagnosis codes come from the International Statistical Classification of Diseases, 10th revision (ICD-10) codes, developed by the World Health Organization. Procedure codes come from Current Procedural Terminology (CPT) codes, developed by the American Medical Association.
Every time a physician writes a clinical note, performs a procedure, orders a test, or has any sort of patient encounter, the electronic medical record (EMR) asks for an ICD-10 code. Go to a primary care office, and the doctor will want to bill for every issue discussed that day, so multiple ICD-10 codes will be entered.
The ICD-10 coding system is so specific and complex that multiple different codes exist for similar problems. The primary care physician might simply put in M54.9 (back pain) but when they come see me, the neurosurgeon, I know to put in M48.061 and M54.16 (lumbar spinal stenosis without neurogenic claudication but with radiculopathy). I could probably add in M51.16 (displacement of lumbar intervertebral disc with radiculopathy) as well. Of course, I’m not going to go through the trouble of deleting the primary care doctor’s initial assessment. He had written notes associated with it. Now the patient’s problem list has four items listed for one issue.
He might be a new patient to our clinic, so I would like to add his diabetes to the problem list. I can’t just add E11.9 (diabetes), as that is far too generic for our EMR, so popup boxes appear after I select “diabetes.” What type of diabetes, how long has the patient been on insulin, what are their complications, how severe is their retinopathy and/or kidney disease? In all, there are 58 different boxes (I counted) to click through to get the “accurate” diabetes diagnosis. Of course, being a neurosurgeon, I have no clue about this patient’s diabetes complications or retinopathy. Information on differing insulin types left my brain long ago. So I click through as best I can. After a few frustrating seconds, I arrive at Z79.4. I’m sure his primary care provider will come up with a much more accurate and detailed ICD-10 code which will join my Z79.4 on the patient’s problem list. The same must be done for his hypertension, headaches, acid reflux… Eventually, I just give up. His problem list already takes up the entire page. I don’t envy those poor primary care doctors.
The complexity of the ICD-10 coding system clearly explains how our homeless gentleman received a NASA-related diagnosis. Some provider, likely rushed for time, was clicking through and simply chose the wrong code. An encounter with extraplanetary craft is not the only obscure condition enshrined with its own ICD-10 code. If one is trying to enter a bone marrow disorder, one might mistakenly click on W61.111XA (bitten by macaw). Perhaps a problem with fluid retention is mistaken for V91.07XD (burn due to water-skis on fire, subsequent encounter). Of course, if a physician is ever searching for a code to use, there’s always Z63:1 (problems in relationship with in-laws).
But, no, alas our poor homeless man just had Z59.0 (homeless single person) and F15.929 (methamphetamine intoxication, not to be confused with F15.10 [methamphetamine abuse] or F15.11 [methamphetamine use disorder, early remission]). I still haven’t had the pleasure of treating an astronaut.Published in