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Joel Diamond 5/20/09

May 19, 2009 News 5 Comments
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What’s Wrong with ICD

I suppose only geeky doctors amuse themselves like this: my medical partner and I used our EMR messaging to send ICD-9 related insults to each other throughout the day.

For instance, I pointed out that his E828.9 (accident involving animal being ridden) was undoubtedly due to his 302.1 (zoophilia arotica). This was after he accused me of frequent CPT 54450 (foreskin manipulation). Clearly this was one of the most flagrant examples of religiously-inaccurate coding, by the way. Besides, I told him that he should be so lucky with his 752.65 (hidden penis). All this led to a serious E960.0 (unarmed brawl).

Why is ICD-9 so rich in its expression of seemingly silly/worthless diagnoses, but falls so short in reflecting the realities and nuances of day-to-day medical care? No doubt, that it has been widely used as a tool for billing. I suppose that someone finds the need to accurately code for E928.4 (accident due to constriction by hair), and am fascinated by the ability to drill down to great detail, such as E910.2 (water activity injury without diving board). Much has already been written about the need to document E845.9 (spacecraft injuring another person).

What about the heralded switch to ICD-10? I’m not sure how the 318 codes for diabetes mellitus are going to be helpful, but I an so glad to know that there will be V32.22  (Occupant of three-wheeled motor vehicle injured in collision with two- or three-wheeled motor vehicle, person on outside of vehicle, nontraffic accident, while working for income).

Like many physicians, I didn’t worry too much about this before EMR adoption. I admit that I would scribble a single diagnosis on my superbill and let my billing staff “do the rest”. When I first used an EMR, I was shocked to find out that I needed to specify an ICD-9 code in order to complete my documentation. One of my earliest frustrations with adoption was the difficulty in finding the code that I needed. Fibromyalgia could only be documented as “myalgia and myositis unspecified” (729.1). I had to search for a long time to find a code for hemochromatosis—finally deciding it was 275.0, (disease of iron metabolism).

Despite the “geekiness”, controlled medical vocabularies and semantics will have to be tailored to the needs of “real” doctors as we move forward with HIT adoption.

In the meantime, I hope that you don’t get E905.4 today (bitten by a venomous centipede) or know anybody with the misfortune of a 929.0 or 937.0 (look them up yourself!)



Joel Diamond, MD is chief medical officer at dbMotion, adjunct associate professor at the Department of Biomedical Informatics at the University of Pittsburgh, and a practicing physician at UPMC and of the Handelsman Family Practice in Pittsburgh, PA. He also blogs on interoperability.

Comments 5
  • A truly wonderful, geeky read, Joel. Most likely only truly appreciated by coders and EMR-enabled (EMR-burdened?) docs..or perhaps those pirates among us who have had the misfortune of a diagnosis of E832.0 – Accidental Fall from a Gangplank.

  • Best thing I’ve read all week! And I thought I was weird for teasing my co-worker that she must have a 221.2 and calling into work sick and only telling my non-coder boss that I have 787.91. Also glad to hear from someone who hasn’t jumped on the ICD-10 bandwagon.

  • Hopefully the crew of the space shuttle Atlantis will land safely this weekend, and not experience any E845.0.

  • Joel, great food for thought. Esspecially when clients or prospects are so interested in having ICD10 available, appears to be just one more task to provide an incredible “cross reference” program for in the EHR software to make the leap from ICD9 to ICD10. Hope you are well!

  • If you were having issues with 780.59 (sleep problems) becuase of Kluver Bucy Syndrome (310.0)or your spouse suffered from 302.79 (coitus avoidus) and the man in house with 607.89 (atrophy of important body part)… your physician might have to spend enought time with you to qualify for a level 4 visit…or he or she might develop 315.39 (speechless)

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