There seems to be some misunderstanding what is meant by "subsequent encounter" in this context. These are codes for office visits. "Subsequent encounter" means that a patient is not seeing a physician for the first time about their injury. There are also codes for "initial encounter."

Wait, you mean they're not talking about someone having been struck by a spacecraft for the second time?

So initial vs subsequent encounter are completely different codes? Wouldn't this approach double the number of codes? Why wouldn't this be some other field of data associated with the form instead of mixing it up in the diagnostic 'topic'.

I know nothing about medical diagnosis codes.

Medical diagnosis codes are all about reimbursement. Doctors do not rely on coding so much as finance dept relies on coding.

Proper coding means more $$, so talented dx coders are valuable.

Separating the code this way may not make sense medically, but it makes a lot more sense when you realize CMS or Blue Cross wants more coded granularity for automatic transmission of accurate financial information.

What does this have to do with anything? Is it just to inject a bit of cynicism?

Because while there's certainly a lot to be gained by a bit of creativity with the coding, the first/subsequent encounter distinction is ill-suited, considering these are binary categories, and any mistakes/attempts to defraud can detected with an sQL query shorter than this paragraph.

Concerning the original question: it's basically denormalized, with the usual tradeoffs. I'd guess it's easier to double the number of codes than to add a new attribute to legacy systems.

Dx codes are a big part of my programming world, I work on medical software. Not trying to be cynical, just offering an insider perspective from someone who just helped hundreds of hospitals and thousands of agencies complete the ICD-10 switch seamlessly with no rejected 485s, no rejected 837I(5010)s or other payer rejections.

Not trying to be cynical, just trying to offer a view into the requirements set before me.

Medical codes date back before modern computer systems - this is what legacy process looks like.

My understanding is that codes are simply a lookup into the structured version of the above document; they aren't "parseable" any more than an MD5 hash is parseable, but they uniquely identify a combination of conditions. As other posters have noted, the complexity required to implement that lookup table is an intentional barrier to entry.

There is a format to the code that allows any code to indicate initial vs. subsequent. It is important for looking for first visit cure vs. multiple visits to cure a condition.

Pretty sure its just a suffix That indicates a second encounter with the patient

Looking at the examples, they end with A for initial and D for subsequent visits.

The codes are used to make the reimbursement system complicated enough that it can be gamed. That's the general purpose of impenetrable bureaucracy.

Actually it's worth reminding that it's the opposite that is true. Bureaucracy, paperwork, are the only known ways to reduce gaming and enforce equal access to justice. O boy I hate paperwork, but it's there for a reason, a good reason.

Maybe that's the intention, but like code, the more complex you make e.g. tax laws, the greater chance there are loopholes (bugs). And there certainly are loopholes, if corporations' low/zero tax rates are any evidence.

It's not really equality when you raise the barriers to entry by giving larger companies an advantage when they can hire people who know how to game the rules, or who can hire lobbyists to write the rules in their favor, or get their own people into said bureaucracy (regulatory capture) and the little guys just don't have the money for any of that. You prevent people from entering the market, resulting in reduced competition.

I've been a HN lurker for a long, long time. Just wanted to say I created an account specifically to upvote this. Thank you.

It's okay and there is no need to be shy about making comments or voting for things. Now that finally, after all this time of being a bystander, your parent convinced you to take this step, please tell us about your story. I just mean to say that person you thanked seemed quite emotional. And you made an account, and thanked them. But I cannot really see what's so special about money turning into more money. That's why you went to primary school. A few dollars made you able to read and write, and now you're using it to save dollars or make more dollars.

So please: expand on the emotion now you've taken the plunge.

That is the initial purpose. Unfortunately bureaucrats tend to value other bureaucrats highly. It's a self perpetuating bureaucracy machine.

"The bureaucracy is expanding to meet the needs of the expanding bureaucracy."

Transparency is the only known way to enforce equal access to government services. Bureaucracy is used to thwart that, via complication that can only be unraveled by (often very highly paid) specialists.

I'm not even sure how you can state that paperwork enforces equal access to justice. It certainly isn't working in the United States, unless you know of magical paperwork that will stop cops from choking black people to death.

An initial consultation is more in-depth, as the doctor is gathering information and diagnosing, whereas subsequent consultations are more about monitoring and fine-tuning the issue. Usually they're also shorter.

A subsequent encounter must be a followup visit.

Some more:

W2202XA Walked into lamppost, initial encounter

W34111A Accidental malfunction of paintball gun, initial encounter

W5629XA Other contact with orca, initial encounter

Y36511D War operations involving direct blast effect of nuclear weapon, civilian, subsequent encounter

V657XXA Person on outside of heavy transport vehicle injured in collision with railway train or railway vehicle in traffic accident, initial encounter

Y92331 Roller skating rink as the place of occurrence of the external cause

Erm, there is a website for W2202XA: http://w2202xa.com/

Would have been funnier if it linked to people walking into lampposts videos.

Hello! Sorry, I'm just here to watch the flowers grow

$10/yr well spent

Maybe he is targeting a über niche that is so obscure that it becomes abstract.

but... why did you know that?

i'm sure the parent just searched for the string.

What a weird web page and url.

Looks like it was just thrown up as text in html, but there's a container, so maybe someone actually applied CSS to that little tidbit?

Nope, a blockquote inside a blockquote. Interesting html-only container!

News you can use

> Y36511D War operations involving direct blast effect of nuclear weapon, civilian, subsequent encounter

If there's a nuclear war, I'm glad we'll still have the healthcare industry around to keep our priorities straight.

I'm curious about whether the "civilian" refers to the nuclear weapon or the person getting the diagnosis

"Other" contact with orca? does it means that there are three or four specific types for orca contacts previously defined?

W5564WTF contact with orca, left fin, just a scratch, subsequent encounter

It's pretty funny to think that somewhere in my insurance record is the code W2202XA.

Don't forget: C5432XXA Took an arrow to the knee, former adventurer

>Other contact with orca

This one calls for serious investigation. Dirk gently style.

"Other contact with orca", whatever that means, sounds slightly naughty.

If you like these you might also enjoy ICD-10 illustrated. [0]

http://www.icd10illustrated.com/

They found a lot of great codes. One of my favorites from the book: V91.07xD Burn due to water-skis on fire, subsequent encounter.

Thanks for helping me along my Christmas shopping! This is great for those who work in healthcare...

> V9543XD Spacecraft collision injuring occupant, subsequent encounter

Hold on, hold on: when you say 'spacecraft', do you mean complete space vehicles, which would be 336414, or space satellites, communications, which would be 334220?

http://www.census.gov/eos/www/naics/

Reminds me of some of NJ's (and other's, I imagine) state laws:

> 39:4–128.4 Improper passing of frozen dessert truck

Your honor, those desserts weren't frozen! (Jury gasps)

A well-known NJ law among truckers. Do not pass the ice cream truck. You might kill a child.

Your honor, it was 103F. How was I to know the truck was frozen?

I don't even... why in the world would it be important for a doctor to differentiate being struck by a dolphin or struck by orca (side note: orcas are dolphins!).

I believe it's for statistical purposes(if it's anything like death codes here in Aus).

If there is an uptick in dolphin strikes, the Government(or some environmental management group) may do something about the dolphin problem.

Speaking of Australian death codes: http://deathmatch.me/

Or if there's a sudden lack of dolphin related accidents it might be good to look into whether or not the end of the world is eminent[0].

[0] http://hitchhikers.wikia.com/wiki/Dolphins

Wouldn't it also hide increases of "injured by a sea creature" that could be more useful in policy making.

I don't think so, though I don't know in practice I imagine there would be categories that aggregate the individual codes.

The only semi-plausible explanation is some weird insurance plan crafted for sea-world (et-al) staff. Neither Orcas nor (other) Dolphins were ever recorded to attack human beings out of captivity anyhow.

Unless an over-amorous encounter could be considered an attack. Seems to be a real problem, wonder if there's a code for 'loved to death(drowning) by dolphin'

https://www.google.com/#q=dolphin+amorous

This was puzzling me (as a UK citizen). A clue in another comment hinted that it is about insurance.

Still not sure why a dolphin would be covered in a policy but not an orca...

I don't think that it would be used to decide whether an incident was covered or not, just to categorize it for statistical purposes or something.

It's the kind of data that might be used to say "shark attacks are up 23% on the US east coast over the last three years".

It would be interesting to read a design document (or post-hoc technical analysis) that enumerates all the purposes that medical billing codes are used for. Maybe it would explain the easily-mocked craziness.

Orca is a "killer" whale -- you were duly warned. ;)

These are diagnosis codes, so it wraps up to national-level reporting - i.e. 35 people were injured by dolphins this year.

Also, insurance companies get crazy nit-picky with what types of treatment they'll cover for diagnoses. There is an entire industry around scrubbing claims and making sure treatment meets the diagnosis codes.

Pretty sure my co only covers Dolphin and NOT Orca strikes.

Insurance billing. These need to be exact in order to correlate to a) rates negotiated b) data collected for future underwriting c) exact repayment. Medical billing is a crazy world.

Isn't all this coding a U.S. phenomenon? I've read that single-payer systems like Canada's require orders of magnitude less labor and paperwork.

In the UK there is still a lot of this, even though healthcare is centrally funded and (somewhat) centrally administered.

I worked briefly with a company doing medical transcription. It opened my eyes to how much billing-related paperwork goes on in hospital back offices.

Probably because orcas are so much larger.

Clearly that is the medical code for being struck by a Mahi-mahi, which can reach nearly 60lbs and travel at speeds above 55mph. /end sarcasm

Severity of injury?

I've gotta believe that some dolphin injuries are more severe than some orca injuries.

At any rate, once the code describes a situation so specific that it may only classify a few injuries a year, what possible benefit may come from that?

Am I missing a table since I can find the orca thing, but it doesn't have a listing for bear. Please tell me bears are a bigger danger than orcas?

// holy crud, the comment section is now a rabbit hole - good job karim

Yeah, bears are not specifically mentioned. You'd have to file it by W55.8: contact with other mammal.

You guys are either pulling my leg, or I just entered a Volgon message board by mistake.

Nope, we are quite serious. Download https://www.cms.gov/Medicare/Coding/ICD10/Downloads/2016-Cod... and enjoy.

So, an orca (9 codes) and a squirrel (6 codes) have their own damn codes but a friggin bear is in the other category?!? Heck, wolves, coyotes, bears, and mountain lions all don't have their own codes. I see a lobbying effort that needs to go on to show the true nature of dangerous animals in the US and quit hiding these attacks in the other category.

On the other hand, I do like the difference between cats and dogs:

  W540XXA Bitten by dog, initial encounter
  W540XXD Bitten by dog, subsequent encounter
  W540XXS Bitten by dog, sequela
  W541XXA Struck by dog, initial encounter
  W541XXD Struck by dog, subsequent encounter
  W541XXS Struck by dog, sequela
  W548XXA Other contact with dog, initial encounter
  W548XXD Other contact with dog, subsequent encounter
  W548XXS Other contact with dog, sequela
  W5501XA Bitten by cat, initial encounter
  W5501XD Bitten by cat, subsequent encounter
  W5501XS Bitten by cat, sequela
  W5503XA Scratched by cat, initial encounter
  W5503XD Scratched by cat, subsequent encounter
  W5503XS Scratched by cat, sequela
  W5509XA Other contact with cat, initial encounter
  W5509XD Other contact with cat, subsequent encounter
  W5509XS Other contact with cat, sequela

Conspiracy theory: the diagnosis codes were compiled by Bears who tried to avoid attention to their own kind.

My parents are MDs, and they hate this stuff. Mostly because the onus is on doctors to perfectly use the correct code or not get reimbursed. (Or more realistically, waste time arguing with insurance companies/Medicare to get reimbursed.)

Sadly, my first job out of college involved these codes after we wrote a rural health grant. The money and pain that went into that thing still wakes me up at night. The codes (and the cost of acquiring the "book" along with filling out the forms) gave me fits and actually made me think heavily about calling in sick for work each morning in the shower.

There must be a code for that...

ICD10-code induced trauma and anxiety, initial encounter

Sounds likely to be

F4311 Post-traumatic stress disorder, acute

I would expect its more the domain of the other document I dread: the DSM-IV

Interestingly, I heard about that a couple of months ago going to a med conference and listening to Atul Butte. Here is the longer narrative of the taxonomic structure of death causes:

https://youtu.be/pY5_KSMlAUQ?t=105

(By the way, the rest of Atul's talk is also quite interesting, too, for people who are looking for building the next open-source bio/medical-informatics company in their garage.)

Z62891 Sibling rivalry

Y93G2 Activity, grilling and smoking food

Y9286 Slaughter house as the place of occurrence of the external cause

Y6553 Performance of correct procedure (operation) on wrong side or body part

X962XXA Assault by letter bomb, initial encounter

X05XXXA Exposure to ignition or melting of nightwear, initial encounter

I can think of examples of all of these. But I did have siblings, burn myself bbq'ing, know people who worked in the local slaughterhouse (knife in the arm to get off work), know of a surgeon who made this terribly sad mistake, live in the UK (IRA letter bombs).

Ok, I kinda give up on the last one.

I knocked one of those quartz desklamps over on my bed when I was asleep. Set the blanket on fire, caused it to melt. Fortunately, I was awakened before I was injured. Not sure if that would count, though.

Sibling rivalry is a serious condition where your young child is trying to harm or murder your new baby.

> Y6553 Performance of correct procedure (operation) on wrong side or body part

That's horrifying.

When I was younger, I had a commercial-grade stapler (the big ones that advertise stapling through N-hundred sheets at once) go into my pointer finger on my left hand. The resulting bone infection eroded all the bone in my fingertip, which was reconstructed later from "donor" bone.

Step one of the operation was getting taken back to a patient room, being given an IV (since I was not to eat or drink for 12hours before the operation), and waiting. After a few hours, a nurse walked in with a sharpie and wrote "NO" on my other hand.

It wasn't comforting.

It happens. http://www.nytimes.com/1995/09/17/us/doctor-who-cut-off-wron...

Coincidentally, two posts talking about this kind of never event, with links:

https://news.ycombinator.com/item?id=12773709

They do happen, but they're quite rare.

Most applicable to our profession is that of T43.616A:

Underdosing of caffeine, initial encounter

A "rabbit hole" for you... A major annoyance for me (a paramedic). Accurately categorizing the stupidity humanity can be surprisingly time consuming...

Some more:

Z621 – Parental overprotection

Z631 – Problems in relationship with in-laws

R460 – Very low level of personal hygiene

Z731 – Type A behavior pattern

R461 – Bizarre personal appearance

Interesting this should pop up, a few weekends ago I put together a simple quick search for ICD-10 codes (and Radlex, a radiology specific lexicon) at http://lex.orionmd.com. I'm sure there are other more powerful tools out there, but feel free to play around!

Apropos. Thomas Morris' excellent blog about historical medical cases is super interesting, using reports from old medical journals as source. Eg "The woman who peed through her nose":

http://www.thomas-morris.uk/

well done! Responses are evident enough for this being a rabbit hole. :)

My wife studies domestic violence and notes that there is no code for strangulation. Talk about bike-shedding.

How about T71.193A? http://www.icd10data.com/ICD10CM/Codes/S00-T88/T66-T78/T71-/...

wow, thanks!

Are these added added to the database as needed, or did a (group of) bureaucrat(s) make these up in one sitting?

Y385X3A Terrorism involving nuclear weapons, terrorist injured, initial encounter

Those are oddly specific.

And still no code for "close encounter", tsk tsk

W621XX Contact with nonvenomous toads

The best has to be V97.33XD Sucked into jet engine, subsequent encounter

Just in case you survived.

Probably just a hair less unlikely than you had previously thought. Who can forget this early YouTube classic:

https://m.youtube.com/watch?v=HeLbtltuB5g

My favorite: W61.62 Struck by duck