Sometimes we encounter morbidity and mortality conditions that are amusingly unconventional and idiosyncratic to apply the International Statistical Classification of Diseases and Related Health Problems, 10th revision (ICD-10) code or the 2015 American International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes.

Let’s delve into the infographic below (click on the infographic to view a larger image in a new tab of your current window) from Healthcare IT News  (a publication of  HIMSS Media which is a media organisation serving today’s healthcare industry, including all major healthcare organisations), and hope to find appropriate ICD-10 codes for them.

On verifying the codes given in the infographic, I found them to have similar variations in ICD-10 when compared to the ICD-10-CM codes. Let’s look in detail each of these 8 zaniest codes using the ICD-10-CM and how the differ when using ICD-10.

The first code from the infographic is Z63.1

It was not quiet easy to find an equivalent code for Z63.1 in ICD-10. In ICD-10 there is Z63 but you will need to cross reference with other codes to find hints for lead terms found among other codes belonging under a three-digit category. For example, Z63.1 is one of the several four-digit categories belonging under the three-digit category Z63.

Since “Family discord NOS” is classified to “Other specified problems related to primary support group” with code Z63.8; but when a family discord in relation to or with parents and in-laws is the situation with a presenting patient, then Z63.1 is the appropriate code.

Another example would be when the patient is a “Dependent relative needing care at home”. If the dependent relative is a parent and in-law(s), then code Z63.1 is the appropriate code since this code qualifies with specificity who the dependent relative is, since the parent or the in-law would be an elder or aged. So rather than using code Z63.6 which is for “Dependent relative needing care at home”, use Z63.1 when the dependent relative is a parent or an in-law.

Asphyxiation due to being trapped in a (discarded) refrigerator, accidental has the ICD-10-CM Diagnosis Code T71.231D, which differs from ICD-10.

ICD-10 differs from ICD-10-CM when two codes for asphyxiation due to being trapped in a refrigerator which may be accidental, one from Chapter IX Injury, poisoning and certain other consequences of external causes  and the other from the Chapter XX External causes of morbidity and mortality.

The ICD-10 code T71 from Chapter IX is used for the asphyxiation from systemic oxygen deficiency due to low oxygen content in ambient air. The ICD-10 code W81 from Chapter XX  is used fo describe the circumstances when the patient was found confined to or trapped in a low-oxygen environment including accidentally shut in or trapped in refrigerator. No mention of “discarded” is found for the ICD-10 code W81 if the refrigerator was indeed discarded.

ICD-10 code V97.3 only specifies if the person on ground injured in air transport got sucked into jet unlike ICD-10-CM which has a unique code when person sucked into jet engine with code V97.33XD, “engine” as the addition qualifying term used here.

The exclusion note for “Falls“ includes falls into water (with drowning or submersion) in ICD-10 is classifiable to codes ranging from W65 to W74 which are conditions due to accidental drowning and submersion. There is no code found for accidental drowning and submersion from a fall into a bucket under codes W65 to W74. So we are left only with using the code W74 “Unspecified drowning and submersion” which includes “fall into water NOS”.

This differs greatly from the ICD-10-CM code W16.221 which is for “Fall in (into) bucket of water causing drowning and submersion”, which could happen if the patient was a toddler.

V91.7 applying the fourth-character subdivision “.7” is the most likely ICD-10 code to use for an accident to watercraft for example a burn to water-skis (which is a watercraft) causing other injury (in this case a burn), when compared to ICD-10-CM V91.07XD for a burn due to water-skis on fire.

Walking into a stationary object is to say “striking against or struck by other objects” describing the ICD-10 code W22. From the infographic, the stationary object is a lamp post. ICD-10-CM uses the code W22.02XD in this instance.

Hair causing external constriction is the cause when an item like hair is causing the external constriction. The ICD-10-CM code W49.01XD is for a subsequent encounter when hair is causing an external constriction. In ICD-10, the equivalent would be to use the code W49 for “Exposure to other and unspecified inanimate mechanical forces”. Here the inanimate mechanical force (the constriction) is from the hair.

Animal-rider injured in collision with streetcar or trolley uses the ICD-10-CM code V80.730A for an initial encounter. I think the ICD-10 code V80 Animal-rider or occupant of animal-drawn vehicle injured in transport accident best describes a similar accident. You will also need to find a ICD-10 code for the injury as a consequence of the external cause.

Infographic credit: http://himt.wisconsin.edu/blog/6-health-information-technology-infographics-need-see-right-now/

Now we have seen how weird some 8 conditions can be, and how we will know exactly which ICD-10 or ICD-10-CM code to use.

References:

1. World Health Organization 2011, Volume 1 Tabular list, International Statistical Classification of Diseases and Related Health Problems 10th Revision, 2010 edn, Geneva, Switzerland
2. 8 zaniest ICD-10 codes, 25 July 2013, Healthcare IT news, viewed 28 February 2015, <http://www.healthcareitnews.com/infographic/infographic-top-zaniest-icd-10-codes>

Ebola virus disease (EVD) – formerly known as Ebola haemorrhagic fever, its outbreak in West Africa with the first case notified in March 2014, and its effects around the world, continues to get news coverage.

As I write this article, the World Health Organisation (WHO) is investigating reports according to three media outlets that an undisclosed number of Islamic State of Iraq and Syria (ISIS) militants displaying signs of Ebola have been showing up at an Iraqi hospital in the ISIS-held city of Mosul, 250 miles north of Baghdad. Thus, Malaysians who are fighting there alongside other ISIS militants – and when they return, are likely to pose a real danger of exposing the Malaysian public with Ebola. Fortunately, the Ministry of Health Malaysia has in place a comprehensive “Guideline on Ebola Viral Disease (EVD) Management In Malaysia” which includes guidelines for healthcare providers to stay alert for and evaluate any probable case,  for example known persons who are returning from ISIS controlled regions. The guidelines ensures screening of an such an individual as a Person Under Investigation (PUI) since he or she was a contact of an EVD case with either a high or low risk.

The World Health Organisation (WHO) warns that the Ebola virus causes an acute, serious illness which is often fatal if untreated. EVD first appeared in 1976 in two African states, and takes its name when the second case occurred in a village near the Ebola River, in the Democratic Republic of Congo.

The International Classification of Diseases (ICD) Ninth Revision i.e. ICD-9 for morbidity and mortality coding was adopted by Malaysia by 1978. Since the Ebola virus was first discovered in 1976, Health Information Management (HIM) / Medical Records (MR) practitioners in Malaysia who had just started morbidity and mortality coding using ICD-9, would have coded any probable case of Ebola as “078.89, other specified diseases due to viruses”.

As the Ebola outbreak heightened after the West African outbreak in 2014, any eventuality of an outbreak in Malaysia will not impede our ability to track and respond to the virus within its own borders and makes it easier to share information with the rest of the world. Malaysia’s ability to immediately track and respond to the Ebola outbreak from a public health perspective will be possible with the specificity in patient data morbidity and mortality coding for EVD using the Tenth Revision of ICD i.e. ICD 10, as Malaysia would be able to use the ICD-10 code for the Ebola virus – A98.4 to assess the efficacy of treatment and outcomes. Malaysia adopted ICD-10 by 1 January 1999 in our morbidity and mortality reporting systems.

The infographic by the Coalition for ICD-10 below (click to enlarge the infographic which will open in a new tab of your current browser window), presents the public health benefits of using ICD-10 in the fight against Ebola.

References :

1. Ebola virus disease, Fact sheet N°103 Updated September 2014, World Health Organisation (WHO),viewed 3 January 2015, ,< http://www.who.int/mediacentre/factsheets/fs103/en/ >
2. Guidelines On Ebola, Ministry of Health Malaysia, viewed 3 January 2015, ,< http://www.moh.gov.my/english.php/pages/view/606 >
3. ICD-10: A Common Language for Public Health, The Coalition for ICD-10,viewed 3 January 2015, ,< http://coalitionforicd10.org/2014/09/04/icd-10-a-common-language-for-public-health/ >
4. ISIS fighters ‘have contracted Ebola’: World Health Organisation investigating reports militants showed up at Iraqi hospital with lethal disease, Mail Online, Saturday, Jan 3rd 2015, viewed 3 January 2015, < http://www.dailymail.co.uk/news/article-2894154/ISIS-fighters-contracted-Ebola-World-Health-Organisation-investigating-reports-Islamist-militants-disease-showed-Iraqi-hospital.html >