Tuesday, March 11, 2003
Code of the Day
One of the minor irritants of practicing medicine these days is coding: in an effort to improve the efficiency of insurance billing, disability evaluations and the Medicare system (among other things) a system of code numbers has been assigned to all diseases and procedures. The standard medical/disease code system is ICD-9 (International Classification of Diseases, ninth edition). Every doctor's office has a copy of this codebook somewhere; every office visit, lab test and disability form has to have an ICD code attached to it for diagnosis. Sound bureaucratic? Yes it is, but that's not why I'm writing about it: I adore the ICD-9 codebook. Yes, I do. Pick it up and you won't be able to put it down; it's more addictive than leafing through an encyclopedia or a dictionary. It's perfect bathroom or rainy-day reading. Many old-fashioned disease names are still included in the codebook, along with syndromes I've never heard of. The perfect example? 784.49 - clergyman's throat (also known as "voice disturbance, unspecified").
The system also sometimes takes exactitude to a ridiculous degree. Under visual loss, we have for blindness 369.0, but for "better eye: total impairment; lesser eye: total impairment" it's 369.01. Then follows every permutation and combination you can imagine of the visual acuity of each eye, all with a different code number.
A few months ago I decided to share my love of ICD-9 codes and started a code of the day mailing list in my medical group. It was received with enthusiasm, more than I had dared to hope for... I just hoped people would find it amusing instead of the final reason they needed to admit me to the psych unit.
Let's look at some examples. In order to play I suggested that the members of my list arm themselves with an ICD-9 codebook and look up the answers, but obviously that's not workable here so I will simply append them.
Hint: Mary had this (V02.1) Answer: Typhoid carrier
I joked that we all had patients with this problem. (301.51) Answer: hospital addiction syndrome, similar to Munchausen's syndrome: a chronic factitious illness, self-induced.
I will leave you with a final thought: 309.23...
Answer: Adjustment reaction with specific academic or work inhibition, also known as spring fever. (Yes, it's really in there.)