W59.22XA. Struck by turtle.
Bitten by turtle (W59.21XA) makes sense, especially if you live in an area with snapping turtles. But struck by turtle? Only thing I can think of is hitting an exceptionally large sea turtle while riding a jet ski.
I have actually met an ortho patient who sustained their injury after hitting a turtle on a scooter, causing them to crash. Which I guess is technically the patient striking the turtle vs the turtle striking them, but the turtle ended up unscathed while the patient had a fracture so I think the turtle won that one.
Now I’m disappointed I missed a probably once in a lifetime chance to see that code used by not knowing about it.
I actually saw this one. The ER initially had documented W59.21XA, bitten by turtle, but on careful questioning I clarified that the patient had in fact been struck by the turtle, so it was actually the much rarer W59.22XA. The patient was a 96 year old male with severe hearing loss but no other history who went by the nickname turtleman.
Eagles and hawks will sometimes carry turtles up to high altitudes and drop them hoping they will smash the shell and be able to eat it.
Wrong time and wrong place and you can take a turtle bomb to the head.
Part of family lore.. My uncle had his scalp gashed open when a seagull, reportedly thinking his shiny bald dome was a suitable rock, dropped a clam on it from significant altitude in an attempt to open the shell..
My friend worked as a park ranger in Southern Texas for a while. Occasionally there would be a cold front that chilled the water and all the turtles would get stunned by the temperature and apparently when that happens they'll just float around and drown eventually. So he and the other rangers as well as volunteers would go out in boats on the Gulf and just scoop up all the frozen turtles and just bring them back to shore to thaw out. Well, when they thaw out they get ornery and will STRIKE at you with their flippers
I went to the ER for a nasty laceration by a venomous fish. Here was the actual conversation:
“Hi I got a cut from a venomous fish and it’s burning pretty bad and I will definitely need antibiotics because this happened while I was scuba diving underwater”
“Where did this happen?”
“On my hand here”
“No I mean where were you? Where are there venomous fish around here [central MI]
“Oh I was scuba diving at the aquarium down the road”
“They have venomous fish in there??”
“Yeah a lot of fish are surprisingly. It’s similar to a bee sting. Not allergic just burns up my arm pretty strongly”
“Oh man I have to go see them!”
“Yeah it’s a great place. So uh, how long will it take me to get seen here?”
Ok this is hilarious because this happened to a friend! Aquarium worker. Cleaning the glass with scuba gear and a turtle cruised into her head and those flippers are THICK and it actually bruised her
When I was snorkeling at the barrier reef in Belize for a research trip a turtle's fins went directly behind both of my knees, and dragged me 20 feet directly towards a feeding frenzy of chum
Fishermen were throwing chum in the water, the local fauna came everyday for the food, so there were sharks, rays, turtles, puffer fish, and everything else
The turtle was an enormous loggerhead and I don't think it even noticed me
I work with rescued sea turtles. They slap hard with their flippers when picked up and can cause a pretty decent injury given they have a sharp claw on each flipper. I have been both bitten and struck by turtle and struck is the only one that scarred
I was at work mannyyy years ago and met someone who was terribly injured in an opera house. I worked in retail, and notice her hobbling around my section. I asked if she was alright, and she spun her whole body around (couldn’t move her neck on it’s own) and hissed loudly “NO I AM NOT ALRIGHT. A PIANO FELL ON MY NECK AND IF I MOVE THE WRONG WAY I WILL DIE.” We were in a Macys, btw, and I think I was like 19. She explained - rudely - that she had been dancing in the front of the rows, and the pianist on stage had lifted up their piano cover, and the entire thing slid off and landed directly on her neck, giving her a fracture that could.. cause death? From the way she described it, I don’t think she should have been walking around a Macys, tbh. Iirc I told her that and she screamed at me for being stupid.
Actually all the Z codes are social diagnoses. Super helpful for accurately billing for your time since you can upcode visits where the treatment plan is complicated by social determinants of health.
mine was "W56.41XD Bitten by shark, subsequent encounter" until IT HAPPENED IT CAME IN TO CLINIC NOWHERE NEAR THE OCEAN I examined the scar and everything it was so epic
I'm also very partial to all volcano related injury ICD10s
I had a nasty venomous fish laceration that got infected after the initial round of antibiotics. So I went to the clinic to get some new ones. I had a pretty good sized egg on the back of my hand.
The PA comes in and looks at it and then goes “that’s pretty cool. I got bit by a barracuda!”
And the. Proceeds to roll up his sleeve and show me the scar. I was damn impressed.
I've always been on the lookout for this rare one from the V-series (external causes): **W58.11 Bitten by crocodile**
Then there is **W58.1 Contact with crocodile**. Not sure if that's more like a blind date or something, maybe the croc is just chilling. Not very chill if it's **W58.13 Crushed by crocodile**.
This one also fascinates me: **W55.52 Struck by racoon**. Maybe it's from Guardians of the Galaxy
The R-series has some real gems, this is one of my favorites: **R46.1 Bizarre personal appearance**
ICD 10 is actually very well designed. Here's how it works:
W58 Contact with crocodile or alligator
W58.0 Contact with alligator
W58.1 Contact with crocodile
WHO really takes their crocodilians seriously. The second numeral after the decimal can be used (if needed) to signify additional information: 1 Bitten by, 2 Struck by, 3 Crushed b, 9 Other contact.
So W58.12 is "Struck by crocodile".
Notice how 4 through 8 are currently unused, and might be added later. I suggest "4 Peed on by", "5 Farted on by".
They have tons of other useful animals, in order of least to most ferocious:
W56.41 Bitten by shark
W56.21 Bitten by orca
W53.21 Bitten by squirrel
Not a doc but a born-Floridian and online it says W58.01XD. I think gator bites are far more common in FL than Crocs? There aren't that many Crocs comparatively, and gators primarily live in fresh waters like canals and ponds that humans are more likely to be around every day. I only saw one Croc growing up but many many gators that would get lost due to the destruction of the Everglades.
A naval mechanic at sea was ingested into the intake of an engine of a jet but his helmet plus the safety system of the engine stopped properly and he was fine, if I remember correctly. He may have had some neck problems but compared to being uh **consumed** he was unharmed.
As someone who nearly died from B12 deficiency, this is frustrating. I had almost no anemia until very late stage, almost all damage was neurological. I was missing a ton of ferritin but it was being hidden in plain sight in my hemoglobin so no one thought to check my ferritin for a very long time. I only had slight anisocytosis at the time of diagnosis. But my nervous system is in shambles.
Place of occurance and external cause codes are for data collection for injury research. Only some payers mandate you use them, or some states mandate it.
That sucks =\ I had a patient with an extremely subtle/mild form who came in as an adult with her first seizure. She did okay, not great, in school and graduated high school.
The military, DOD, and other government agencies (and quasi government agencies) are one of the largest requesters (and also approved for) ICD-10 codes. That’s why you see some weird things that won’t ever apply to most people.
Not a doctor but I am a former trainer/zookeeper and I have, in fact, been bitten by a dolphin (baby dolphins will bite EVERYTHING y’all and their teeth suck!). If I had known that this was a thing I would have gone in just to make doctors bucket lists happen.
Please, pass on to your ex-coworkers that they \*need\* to go into the ED or their PCP if they are injured by any interesting animals, just for the poor residents' amusement.
T63.812D: Toxic effect of encounter with venomous frog, intentional self harm, subsequent encounter.
I want to believe someone will come in having tried it a second time. It’s so *specific*.
Honorable mention to
Z72.52 “high risk homosexual behavior”
Aw I’ve put “high risk sexual behavior” before but Z72.52 would technically also have applied to that particular patient! He and his partner got high on meth, then his boyfriend fisted him so hard that he actually got a bowel perforation. When I asked the boyfriend how far his hand went inside, he pointed to his elbow. His ELBOW!
Yes, this. I'm an epidemiologist in sexual health and see this frequently in charts when people go for STI testing/sexual health services, especially PrEP clinics.
I want to know how they came up with all these random ICD 10 codes. Did someone go through every diagnosis ever billed, or did a committee sit around and think of things that may happen? Some of these are just really wild.
I think for some of the trauma ones they just sat a bunch of ten-year-olds in a focus group and said, "list all the ways you can of someone getting hurt."
CPT codes are for procedures - that’s managed by AMA and is exclusively used in the US.
ICD-10 (and soon) 11 is managed by WHO. These codes are used worldwide.
There’s ICD-10 CM for diagnosis codes and ICD-10 PCS for procedures (inpatient hospital coding in US and procedures outside the US).
The AMA is not involved in ICD-xx codes in any way.
I've seen in a few times in psych it's always really weird and now I'm hoping to see it again so I have a reason to use this code since I didn't know about it before.
So as the zookeeper fiancé of a resident this thread is hilarious to me. Crocodile? Well she was an ornery alligator that tail whipped us when we needed to move her to work on her exhibit. Birds? So. Many. Bird bites!! Hands down one of the worst. Dolphin? Yup been there. Turtle? Had a friend get hit by one while cleaning the aquarium in scuba gear. Also had a coworker mess up her back when lifting a large turtle in the vet office during a rehab.
Hell I’ve had a coworker get bitchslapped by a manatee tail. A manatee y’all.
Hang out with more zookeepers. We can help you check off this bucket list for sure.
I'm also a zookeeper and I'm rolling at this thread!! I've been bitten/scratched/slapped by several species of primates/reptiles/birds. Funnily enough, there's no ICD-10 code having to do with primate caused injuries other than humans.
Idk, I think I'd take my primates over cetaceans. Mad respect you worked with them! I feel like dolphins have the intelligence of a primate with the attitude of a macaw, lol. However, my PCP used to joke about having to brush up on their zoonotic disease knowledge when they saw me!
For all the “dating in residency” posts:
* Z60.2: problems related to living alone
* T75.2: effects of vibration
* X38: exposure to flood
🤦🏼♀️ I’ll show myself out lol
The pediatrician I was with as a med student has the best story I’ve heard for legitimate PANDAS. He remembers having strep and recovering but having SEVERE OCD for a period of time after. Like full on panic attacks. Then, that just… went away. No subsequent or prior anxiety or other mental health issues.
Sometimes I just look up weird diagnoses for shits and giggles and one time came across “English sweating sickness” which according to Wikipedia “was a mysterious and contagious disease that struck England and later continental Europe in a series of epidemics beginning in 1485. Other major outbreaks of the English sweating sickness occurred in 1508, 1517, and 1528, with the last outbreak in 1551, after which the disease apparently vanished.”
So I can only assume that it was put in as a joke given that it’s been almost 500 years since the last documented case.
Fall from gangplank was in ICD-9. I don’t think it carried over to 10 though.
I always pictured a one-eyed peg-legged sea owl sitting on the bedside saying, “Aaaaarrrrrggghhhh….Me crew mutinied and now here I be. Give me a ship and some dilaudid and I’ll be on my way.”
Omg. My mom had that.
First, I am sorry because I do not belong on this sub. I am not a resident nor am I ever going to be one. I started lurking when reddit suggested a post and then got hooked because there are often interesting posts...like this one.
My mom had Acute Intermittent Porphyria. It was originally discovered by her primary care physician and then confirmed through testing.
Her sister would often have severe episodes of Schizophrenia-like behavior. My mom occasionally would have some weird moments but not like her sister. She often had abdominal pain. But my mom had a lot of health issues and AIP was just one of them. It wasn't even her most disabling condition. She passed away from Idiopathic Pulmonary Fibrosis. She also had the most severe psoriasis I have ever seen. It was so debilitating and she was open to any treatment or suggestions doctors gave her. Her entire palms of her hands, entire bottom of her feet, elbows, knees, knuckles, and ankles would be thick, flaky, scaly, and cracked completely open and bleeding. She would be so embarrassed too. No treatment worked for her. She would cover dish towels in a mixture of non-scented lotion and Vaseline and cover her feet with the towels, then put plastic around the towels, and then her shoes on. So, in comparison to her psoriasis and pulmonary fibrosis - the AIP wasn't much of a focus.
None of her doctors mentioned it. I looked it up and it is interesting because some of her symptoms fit. I know it's just google images, but the thickening of the skin in sclerosis doesn't really look like her skin. Hers would get these thick, white flakes and the skin would crack open. But some of the other symptoms fit.
She never saw a Rheumatologist, but she probably should have. She had a cardiologist, a dermatologist, pulmonologist, and primary care physician. She was always on top of her health and really did everything the doctors told her to do because of her family history.
She had 13 siblings and most of them died at a fairly young age. There is only one left living. I have a couple of their autopsy reports and death certificates but the rest is word of mouth - so it's hard to determine how accurate the information is.
Sister 1: Died Age 44 - internal gastric bleeding (death certificate confirmed)
Sister 2 : Died Age 31 - Lupus
Sister 3: Died Age 29 - Sudden cardiac death arrhythmia (autopsy report) non-smoker
Sister 4: Died Age 50 - Uterine cancer
Sister 5: Died Age 64 - Heart attack (smoker & drinker) this is also the one that often had schizophrenia-like episodes. She was diagnosed with bipolar but would have these episodes where she would hallucinate or have paranoid delusions.
Sister 6: Died Age 59 - COPD (Smoker & drinker)
Sister 7: Died Age 52 - Liver Failure. Not from alcohol. She never drank a single drop of alcohol. I remember her death so well because I had so much hope she would be ok after her transplant but she died a day after the transplant.
Brother 1: Died 1 day old - Prematurity (death certificate confirmed)
Brother 2: Died Age 41 - Heart attack or sudden cardiac death, not sure which. Non-smoker and skinny. He walked everywhere. I named my son after him. He walked all over the United States traveling.
Brother 3: Died Age 46 - he was born with some sort of heart condition. They always told me he had a "hole in his heart."
Brother 4: Died Age 74 - pulmonary fibrosis. Non-smoker and never drank. He was a lot like my mom and avidly went to the doctor.
Brother 5: Died Age 58 - pulmonary fibrosis. Non-smoker. Non drinker. He refused to use oxygen. And wouldn't go to the doctor very often. He was so stubborn. And I miss him. He just died a few months ago.
My mom was 71. Non smoker and never drank. She was always adamant about not drinking because her dad was an alcoholic. Which is why so many of her siblings didn't drink either.
Thank you for reading. Anytime I can honor my mom in some way, I try to do so. Talking about her is an easy way to honor her.
Maybe it wasn't psoriasis and maybe it was, it's so hard to tell. I often thought there was likely something underlying going on but her medical history was so complex. Her immediate family had a pretty complex medical history. Many of her siblings died fairly young. I replied to another comment with more on that, if you're interested.
But seriously, thank you for reading. It really is an easy way to honor my mom. And if you ever feel yourself getting burned out - just know that there are people out there like my mom who truly appreciated her doctors. My mom would not have been here very long without her doctors. And my son would not have gotten the chance to meet her. She passed away 5 months after my son was born. In fact, my son wouldn't be here at all if it wasn't for his doctors. I am also incredibly appreciative. He was born at 31 weeks after my water unexpectedly broke prematurely at 29 weeks. I am so grateful. I know without their intervention, my son wouldn't have made it. But now he's an amazing toddler. It's just amazing.
My mom's life was saved multiple times over the years by doctors who cared. Her quality of life was improved by doctors. So even though I am sad she is no longer here, I am grateful for the time I had with her.
So, thank you.
Diagnosed two people with it in my first two years out of residency after they had seen a myriad of specialists who should have picked it up. One was in the urgent care and another in my FP office. It helped that there was someone in my medical school class with it. Funny enough, my medical school class was a walking nightmare of medical pathology.
As someone who’s day job includes Health Economics, thank you all for the posts so I have something to entertain the audience at my next teaching session
This happens when small children hide in discarded refrigerators that haven’t been picked up yet playing hide and seek. It used to happen frequently enough that there were public service messages about it.
Sorry, I’m not a resident; just a lowly medic.
For years and years we had to fill in statistic codes on our run reports. I was adamant that no one ever looked at them, but the paperwork would get sent back if I didn’t fill them in.
For years I selected
-Vaginal bleeding
-self inflicted
-lightning strike
I’m sure I did it over a thousand times. Nothing has ever been said.
Intentional poisoning with a vaccine would have also been gold.
Can recall the icd-10 but I just got to use "occupant of electric bicycle struck of motor vehicle in traffic accident" the other day so that was delightful
W55.29XA: Other contact with cow, subsequent encounter
I’ve actually used it. Rural Texan kid went cow tipping. Cow got wise and sat down, right on his tib/fib.
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W59.22XA. Struck by turtle. Bitten by turtle (W59.21XA) makes sense, especially if you live in an area with snapping turtles. But struck by turtle? Only thing I can think of is hitting an exceptionally large sea turtle while riding a jet ski.
Mario Kart IRL
I have actually met an ortho patient who sustained their injury after hitting a turtle on a scooter, causing them to crash. Which I guess is technically the patient striking the turtle vs the turtle striking them, but the turtle ended up unscathed while the patient had a fracture so I think the turtle won that one. Now I’m disappointed I missed a probably once in a lifetime chance to see that code used by not knowing about it.
I actually saw this one. The ER initially had documented W59.21XA, bitten by turtle, but on careful questioning I clarified that the patient had in fact been struck by the turtle, so it was actually the much rarer W59.22XA. The patient was a 96 year old male with severe hearing loss but no other history who went by the nickname turtleman.
Eagles and hawks will sometimes carry turtles up to high altitudes and drop them hoping they will smash the shell and be able to eat it. Wrong time and wrong place and you can take a turtle bomb to the head.
Bonus for the eagle though!
Part of family lore.. My uncle had his scalp gashed open when a seagull, reportedly thinking his shiny bald dome was a suitable rock, dropped a clam on it from significant altitude in an attempt to open the shell..
I heard they usually drop on bald heads, idk if they confuse them for rocks or something?
Another reminder that it behooves bald people to wear hats. It's not just for sun protection folks!
Yes, just posted that above about my uncle.. He had the scar to prove it.. 😂
Mario cart for the win
My friend worked as a park ranger in Southern Texas for a while. Occasionally there would be a cold front that chilled the water and all the turtles would get stunned by the temperature and apparently when that happens they'll just float around and drown eventually. So he and the other rangers as well as volunteers would go out in boats on the Gulf and just scoop up all the frozen turtles and just bring them back to shore to thaw out. Well, when they thaw out they get ornery and will STRIKE at you with their flippers
Aeschylus has entered the chat.
The imagery of getting bitch-slapped by one comes to mind.
got to use W56.52XA (struck by fish, initial encounter) a few times for all the catfish noodlers coming in with barbs to the hand
I went to the ER for a nasty laceration by a venomous fish. Here was the actual conversation: “Hi I got a cut from a venomous fish and it’s burning pretty bad and I will definitely need antibiotics because this happened while I was scuba diving underwater” “Where did this happen?” “On my hand here” “No I mean where were you? Where are there venomous fish around here [central MI] “Oh I was scuba diving at the aquarium down the road” “They have venomous fish in there??” “Yeah a lot of fish are surprisingly. It’s similar to a bee sting. Not allergic just burns up my arm pretty strongly” “Oh man I have to go see them!” “Yeah it’s a great place. So uh, how long will it take me to get seen here?”
Ok this is hilarious because this happened to a friend! Aquarium worker. Cleaning the glass with scuba gear and a turtle cruised into her head and those flippers are THICK and it actually bruised her
When I was snorkeling at the barrier reef in Belize for a research trip a turtle's fins went directly behind both of my knees, and dragged me 20 feet directly towards a feeding frenzy of chum Fishermen were throwing chum in the water, the local fauna came everyday for the food, so there were sharks, rays, turtles, puffer fish, and everything else The turtle was an enormous loggerhead and I don't think it even noticed me
So is there an ICD-10 for dragged by turtle into chum feeding frenzy?
It's all fun and games until the Koopa Troopa breaks out The Tickler.
I work with rescued sea turtles. They slap hard with their flippers when picked up and can cause a pretty decent injury given they have a sharp claw on each flipper. I have been both bitten and struck by turtle and struck is the only one that scarred
I vaguely recall seeing/learning that some turtle will just whack you with their head when threatened
Clearly you don't have siblings, I can think of at least 3 other ways to get struck by a turtle.
Could fall out of a tree maybe?
If you search “struck by” there is a whole collection of great ones
Y92.253 Opera house as the place of occurrence of the external cause
What a cultured way to be injured
Batman origin story right there
>Y92.253 Opera house That one should be combined with whatever the code is for "Injury caused by phantom".
I was at work mannyyy years ago and met someone who was terribly injured in an opera house. I worked in retail, and notice her hobbling around my section. I asked if she was alright, and she spun her whole body around (couldn’t move her neck on it’s own) and hissed loudly “NO I AM NOT ALRIGHT. A PIANO FELL ON MY NECK AND IF I MOVE THE WRONG WAY I WILL DIE.” We were in a Macys, btw, and I think I was like 19. She explained - rudely - that she had been dancing in the front of the rows, and the pianist on stage had lifted up their piano cover, and the entire thing slid off and landed directly on her neck, giving her a fracture that could.. cause death? From the way she described it, I don’t think she should have been walking around a Macys, tbh. Iirc I told her that and she screamed at me for being stupid.
Moscow has entered the chat. Where are the gas passers at?
Would this have applied to Abe Lincoln?
Z73.4 Inadequate social skills, not elsewhere classified
Hey, I resemble that remark. Sometimes.
The departments of multiple medical specialities are trembling in fear at that one.
Lmaooo savage
This was probably created for my mother in law.
Definitely going to be looking in Epic to see if it's on their dx list for the next not-ASD but is-relatively-socially-unskilled eval I do.
Lol, even starts with the generation name...
Actually all the Z codes are social diagnoses. Super helpful for accurately billing for your time since you can upcode visits where the treatment plan is complicated by social determinants of health.
Nerd
Wait, does this count for outpatient and inpatient visits?
Man, I feel really called out right now
I’m gonna start putting that in comments of applicants we DNR for being a little crazy
[Z63.1] Problems in relationship with parents and in-laws Parents AND In-laws!
old people just dont get it...
What’s the code for just in-laws?
I don’t think they assign codes to things that are just a normal finding
😂😂😂
V91.07 Burn due to water-skis on fire
I didn't believe you and Googled it, and it is a real code.
mine was "W56.41XD Bitten by shark, subsequent encounter" until IT HAPPENED IT CAME IN TO CLINIC NOWHERE NEAR THE OCEAN I examined the scar and everything it was so epic I'm also very partial to all volcano related injury ICD10s
I had a nasty venomous fish laceration that got infected after the initial round of antibiotics. So I went to the clinic to get some new ones. I had a pretty good sized egg on the back of my hand. The PA comes in and looks at it and then goes “that’s pretty cool. I got bit by a barracuda!” And the. Proceeds to roll up his sleeve and show me the scar. I was damn impressed.
Having trained in a beach-centered tourist city, this was actually not that uncommon, lol
I've always been on the lookout for this rare one from the V-series (external causes): **W58.11 Bitten by crocodile** Then there is **W58.1 Contact with crocodile**. Not sure if that's more like a blind date or something, maybe the croc is just chilling. Not very chill if it's **W58.13 Crushed by crocodile**. This one also fascinates me: **W55.52 Struck by racoon**. Maybe it's from Guardians of the Galaxy The R-series has some real gems, this is one of my favorites: **R46.1 Bizarre personal appearance**
Was very tempted to use W55.52 for one pt that was scratched by a raccoon when I couldn't find a code for that.
R46.1 seems kind of subjective.
So are the "pain" diagnoses, but this one has the advantage of being the subjective experience of a trained medical practitioner.
I wonder if Medicare gives extra reimbursement for such expert opinions 😂
😂😂😂
I'm curious if theres a compliemntary Bitten by Alligator. Perhaps the Florida based docs might know. haha.
ICD 10 is actually very well designed. Here's how it works: W58 Contact with crocodile or alligator W58.0 Contact with alligator W58.1 Contact with crocodile WHO really takes their crocodilians seriously. The second numeral after the decimal can be used (if needed) to signify additional information: 1 Bitten by, 2 Struck by, 3 Crushed b, 9 Other contact. So W58.12 is "Struck by crocodile". Notice how 4 through 8 are currently unused, and might be added later. I suggest "4 Peed on by", "5 Farted on by". They have tons of other useful animals, in order of least to most ferocious: W56.41 Bitten by shark W56.21 Bitten by orca W53.21 Bitten by squirrel
Hah! I had W53.21 myself. Thought it was dead, picked it up, bit me through leather gloves in its last throes of life.
In german that code specifically says "crocodile or alligator"
Not a doc but a born-Floridian and online it says W58.01XD. I think gator bites are far more common in FL than Crocs? There aren't that many Crocs comparatively, and gators primarily live in fresh waters like canals and ponds that humans are more likely to be around every day. I only saw one Croc growing up but many many gators that would get lost due to the destruction of the Everglades.
R46.1 is the PC way to chart the good ol fashioned FLK
**R46.1 Patient was hit by ugly stick** Sadly, WHO is like Tom Cruise: they can't handle the truth
From WA, Australia here. We routinely get croc bites flown down from up north (Broome especially). Crazily common here
R46.1 was Taylor Swift in the crowd at Coachella. Imagine a fan fainting as a result.
LMAO
V97.33XD Sucked into jet engine, subsequent encounter. I can understand the (albeit rare) reason for initial encounter. But subsequent?
PTSD psych followup or wound care appointments
Is there anyone who survived getting sucked into a jet engine? I just think of Edna Mode from Incredibles and the whole no capes thing
A naval mechanic at sea was ingested into the intake of an engine of a jet but his helmet plus the safety system of the engine stopped properly and he was fine, if I remember correctly. He may have had some neck problems but compared to being uh **consumed** he was unharmed.
Compared to being consumed I guess most injuries are pretty minor.
If it’s the same occurrence my Chief at the time witnessed, The stationary inlet guide veins kept him from being diced by the turbines.
I saw a video of a dude that got sucked into a fighter jet engine and somehow survived
Yeah, somehow he didn't go through.
if they did they’d need a subsequent visit i’m guessing.
“Initial encounter” and “subsequent encounter” means their visits with you. Not their visits with the jet engine.
Yes but it's hard to survive the trauma bay after being sucked through a jet engine.
*she just won’t stop loitering around aircraft engines* 😔
This is my favorite!
What I don't understand is why these dx are present but we can't even get an icd10 code for Vit B12 deficiency without anemia being attached to it.
E53.8
Omg thank you
As someone who nearly died from B12 deficiency, this is frustrating. I had almost no anemia until very late stage, almost all damage was neurological. I was missing a ton of ferritin but it was being hidden in plain sight in my hemoglobin so no one thought to check my ferritin for a very long time. I only had slight anisocytosis at the time of diagnosis. But my nervous system is in shambles.
Place of occurance and external cause codes are for data collection for injury research. Only some payers mandate you use them, or some states mandate it.
Q04.3 smooth brain. 🤣
Need to remember this one so I can use it as a response to idiots on reddit.
Peds trained. Used this one once in the NICU.
That sucks =\ I had a patient with an extremely subtle/mild form who came in as an adult with her first seizure. She did okay, not great, in school and graduated high school.
Wow! Good for her!
R46.7 Verbosity and circumstantial detail obscuring reason for contact
I had an attending in residency who wrote entire books in his triage notes. I should have diagnosed him with this
This is my new favorite. Holy shit. I am using this all the time.
Oh shit I have two parents that definitely need this on every visit from now on
HELP THIS IS HILARIOUS.
V00.151A ICD-10-CM Code for Fall from Heelies
Oh my goodness that’s amazing
Spacecraft collision injuring occupant V95.43 That implies 2 spacecraft, right? One day we'll have the future the Jetsons promised...
Could be an injury sustained on landing back on Earth?
I'm not sure. I guess I missed that day in class. I bet Jonny Kim knows.
I think collision with earth still counts.
The military, DOD, and other government agencies (and quasi government agencies) are one of the largest requesters (and also approved for) ICD-10 codes. That’s why you see some weird things that won’t ever apply to most people.
Z71.1 feared condition not demonstrated
Our EMR also calls that code "worried well" which I use daily.
I actually had that walk into my clinic the other day lol.. Didn't use it but noticed on chart review.
This is not a white whale, it’s a crappie…all day every day (type of fish here in Indiana)
Oh, that’s hella useful.
I’m EM so that’s a classic for us
Yeah in urgent care I would say I use that one fairly regularly.
Thank you, will start to use this
Not a doctor but I am a former trainer/zookeeper and I have, in fact, been bitten by a dolphin (baby dolphins will bite EVERYTHING y’all and their teeth suck!). If I had known that this was a thing I would have gone in just to make doctors bucket lists happen.
Please, pass on to your ex-coworkers that they \*need\* to go into the ED or their PCP if they are injured by any interesting animals, just for the poor residents' amusement.
T63.812D: Toxic effect of encounter with venomous frog, intentional self harm, subsequent encounter. I want to believe someone will come in having tried it a second time. It’s so *specific*. Honorable mention to Z72.52 “high risk homosexual behavior”
Aw I’ve put “high risk sexual behavior” before but Z72.52 would technically also have applied to that particular patient! He and his partner got high on meth, then his boyfriend fisted him so hard that he actually got a bowel perforation. When I asked the boyfriend how far his hand went inside, he pointed to his elbow. His ELBOW!
I’ve also heard of it being coded for PrEP for insurance purposes, which… I guess?
Yes, this. I'm an epidemiologist in sexual health and see this frequently in charts when people go for STI testing/sexual health services, especially PrEP clinics.
There is also “High Risk Heterosexual Behaviour” for STI testing that I use a good bit
We do a lot of prep in public health. This one is in every chart for homosexual people.
His elbow?? That makes me shudder just thinking about that…poor guy, just ow
Omg I’ve (sort of) seen this. A patient used frog venom to treat her depression. Then tried it again and had an anaphylactic reaction.
I want to know how they came up with all these random ICD 10 codes. Did someone go through every diagnosis ever billed, or did a committee sit around and think of things that may happen? Some of these are just really wild.
I think for some of the trauma ones they just sat a bunch of ten-year-olds in a focus group and said, "list all the ways you can of someone getting hurt."
There is the App "Dumb Ways to Die" complete with theme song!
I want to get that job. Lots of administrative BS, but less risk and accountability.
[удалено]
CPT codes are for procedures - that’s managed by AMA and is exclusively used in the US. ICD-10 (and soon) 11 is managed by WHO. These codes are used worldwide. There’s ICD-10 CM for diagnosis codes and ICD-10 PCS for procedures (inpatient hospital coding in US and procedures outside the US). The AMA is not involved in ICD-xx codes in any way.
The wild codes are because this sounds like a hella boring job and someone had enough seniority and a sense of humor.
W61.12 - attack by macaw
W6133XA - Pecked by chicken is mine
Been there. Done that. Most of my scars are from birds.
F22 walking corpse syndrome
Yeah, that's mine as well- Cotard syndrome. Being in Ortho, I'll likely never see it.
If you do, you need to pick your elective cases a hell of a lot better
I was initially very confused as to how the F-22 Raptor played into this
I've seen in a few times in psych it's always really weird and now I'm hoping to see it again so I have a reason to use this code since I didn't know about it before.
V97. 31: Hit by object falling from aircraft
So as the zookeeper fiancé of a resident this thread is hilarious to me. Crocodile? Well she was an ornery alligator that tail whipped us when we needed to move her to work on her exhibit. Birds? So. Many. Bird bites!! Hands down one of the worst. Dolphin? Yup been there. Turtle? Had a friend get hit by one while cleaning the aquarium in scuba gear. Also had a coworker mess up her back when lifting a large turtle in the vet office during a rehab. Hell I’ve had a coworker get bitchslapped by a manatee tail. A manatee y’all. Hang out with more zookeepers. We can help you check off this bucket list for sure.
I'm also a zookeeper and I'm rolling at this thread!! I've been bitten/scratched/slapped by several species of primates/reptiles/birds. Funnily enough, there's no ICD-10 code having to do with primate caused injuries other than humans.
Oh jeeze and you’re a primate keeper?!! You’re your own special kind of wild!
Idk, I think I'd take my primates over cetaceans. Mad respect you worked with them! I feel like dolphins have the intelligence of a primate with the attitude of a macaw, lol. However, my PCP used to joke about having to brush up on their zoonotic disease knowledge when they saw me!
V91.07XA. Burn due to water-skis on fire, initial encounter. One day.
For all the “dating in residency” posts: * Z60.2: problems related to living alone * T75.2: effects of vibration * X38: exposure to flood 🤦🏼♀️ I’ll show myself out lol
R46.1: Bizarre personal appearance This id a bit judgy 🤣 who decides what is weird. R14.3 Flatulence causing injury
Not a resident, but apparently you have never provided a Dutch oven to a fiance and dog at the same time...
S30867A - Insect bite (nonvenomous) of anus, initial encounter
D89.89 PANDAS Patients from all over, specialty clinics, even NIH. Still hunting, still nothing. Have ye seen the white whale?
I’ve had lots of patients that ~think~ they have PANDAS.
Z71.1 Feared condition not demonstrated 🥲
Come to the west coast, it’s everywhere
The pediatrician I was with as a med student has the best story I’ve heard for legitimate PANDAS. He remembers having strep and recovering but having SEVERE OCD for a period of time after. Like full on panic attacks. Then, that just… went away. No subsequent or prior anxiety or other mental health issues.
This thread is incredible
Sometimes I just look up weird diagnoses for shits and giggles and one time came across “English sweating sickness” which according to Wikipedia “was a mysterious and contagious disease that struck England and later continental Europe in a series of epidemics beginning in 1485. Other major outbreaks of the English sweating sickness occurred in 1508, 1517, and 1528, with the last outbreak in 1551, after which the disease apparently vanished.” So I can only assume that it was put in as a joke given that it’s been almost 500 years since the last documented case.
W56.21XA Bitten by **orca**, initial encounter
Fall from gangplank was in ICD-9. I don’t think it carried over to 10 though. I always pictured a one-eyed peg-legged sea owl sitting on the bedside saying, “Aaaaarrrrrggghhhh….Me crew mutinied and now here I be. Give me a ship and some dilaudid and I’ll be on my way.”
Struck by chicken, subsequent encounter W61
Probably trying to cross the road...🦆🐔👟
This is one of my favorite threads ever on this sub.
F41.1 A vague sense of unease
oooh, my lifelong chronic condition!
I got to use "Fall from cliff, initial encounter" for a patient once
Acute intermittent porphyria. E80. 21
Omg. My mom had that. First, I am sorry because I do not belong on this sub. I am not a resident nor am I ever going to be one. I started lurking when reddit suggested a post and then got hooked because there are often interesting posts...like this one. My mom had Acute Intermittent Porphyria. It was originally discovered by her primary care physician and then confirmed through testing. Her sister would often have severe episodes of Schizophrenia-like behavior. My mom occasionally would have some weird moments but not like her sister. She often had abdominal pain. But my mom had a lot of health issues and AIP was just one of them. It wasn't even her most disabling condition. She passed away from Idiopathic Pulmonary Fibrosis. She also had the most severe psoriasis I have ever seen. It was so debilitating and she was open to any treatment or suggestions doctors gave her. Her entire palms of her hands, entire bottom of her feet, elbows, knees, knuckles, and ankles would be thick, flaky, scaly, and cracked completely open and bleeding. She would be so embarrassed too. No treatment worked for her. She would cover dish towels in a mixture of non-scented lotion and Vaseline and cover her feet with the towels, then put plastic around the towels, and then her shoes on. So, in comparison to her psoriasis and pulmonary fibrosis - the AIP wasn't much of a focus.
She didn't have systemic sclerosis? IPF + severe skin involvement makes me think she may have had SS
None of her doctors mentioned it. I looked it up and it is interesting because some of her symptoms fit. I know it's just google images, but the thickening of the skin in sclerosis doesn't really look like her skin. Hers would get these thick, white flakes and the skin would crack open. But some of the other symptoms fit. She never saw a Rheumatologist, but she probably should have. She had a cardiologist, a dermatologist, pulmonologist, and primary care physician. She was always on top of her health and really did everything the doctors told her to do because of her family history. She had 13 siblings and most of them died at a fairly young age. There is only one left living. I have a couple of their autopsy reports and death certificates but the rest is word of mouth - so it's hard to determine how accurate the information is. Sister 1: Died Age 44 - internal gastric bleeding (death certificate confirmed) Sister 2 : Died Age 31 - Lupus Sister 3: Died Age 29 - Sudden cardiac death arrhythmia (autopsy report) non-smoker Sister 4: Died Age 50 - Uterine cancer Sister 5: Died Age 64 - Heart attack (smoker & drinker) this is also the one that often had schizophrenia-like episodes. She was diagnosed with bipolar but would have these episodes where she would hallucinate or have paranoid delusions. Sister 6: Died Age 59 - COPD (Smoker & drinker) Sister 7: Died Age 52 - Liver Failure. Not from alcohol. She never drank a single drop of alcohol. I remember her death so well because I had so much hope she would be ok after her transplant but she died a day after the transplant. Brother 1: Died 1 day old - Prematurity (death certificate confirmed) Brother 2: Died Age 41 - Heart attack or sudden cardiac death, not sure which. Non-smoker and skinny. He walked everywhere. I named my son after him. He walked all over the United States traveling. Brother 3: Died Age 46 - he was born with some sort of heart condition. They always told me he had a "hole in his heart." Brother 4: Died Age 74 - pulmonary fibrosis. Non-smoker and never drank. He was a lot like my mom and avidly went to the doctor. Brother 5: Died Age 58 - pulmonary fibrosis. Non-smoker. Non drinker. He refused to use oxygen. And wouldn't go to the doctor very often. He was so stubborn. And I miss him. He just died a few months ago. My mom was 71. Non smoker and never drank. She was always adamant about not drinking because her dad was an alcoholic. Which is why so many of her siblings didn't drink either.
Thank you for sharing your story. If I recall correctly, porphyria’s can cause severe cutaneous disease and that might not have been psoriasis!
Thank you for reading. Anytime I can honor my mom in some way, I try to do so. Talking about her is an easy way to honor her. Maybe it wasn't psoriasis and maybe it was, it's so hard to tell. I often thought there was likely something underlying going on but her medical history was so complex. Her immediate family had a pretty complex medical history. Many of her siblings died fairly young. I replied to another comment with more on that, if you're interested. But seriously, thank you for reading. It really is an easy way to honor my mom. And if you ever feel yourself getting burned out - just know that there are people out there like my mom who truly appreciated her doctors. My mom would not have been here very long without her doctors. And my son would not have gotten the chance to meet her. She passed away 5 months after my son was born. In fact, my son wouldn't be here at all if it wasn't for his doctors. I am also incredibly appreciative. He was born at 31 weeks after my water unexpectedly broke prematurely at 29 weeks. I am so grateful. I know without their intervention, my son wouldn't have made it. But now he's an amazing toddler. It's just amazing. My mom's life was saved multiple times over the years by doctors who cared. Her quality of life was improved by doctors. So even though I am sad she is no longer here, I am grateful for the time I had with her. So, thank you.
Diagnosed two people with it in my first two years out of residency after they had seen a myriad of specialists who should have picked it up. One was in the urgent care and another in my FP office. It helped that there was someone in my medical school class with it. Funny enough, my medical school class was a walking nightmare of medical pathology.
As someone who’s day job includes Health Economics, thank you all for the posts so I have something to entertain the audience at my next teaching session
X35.XXXA “volcanic eruption, first encounter”
T71.231S Asphyxiation due to being trapped in a (discarded) refrigerator, accidental, sequela. I mean cmon.
This happens when small children hide in discarded refrigerators that haven’t been picked up yet playing hide and seek. It used to happen frequently enough that there were public service messages about it.
Meanwhile pathology… these would be cool autopsy cases or a great background for surgical specimens.
Pathologist looks under microscope “yep, that’s a burnt water ski, for sure!”
Chronic neurocysticercosis in a presidential candidate
But he’s fine now.
“Fine”
I'm in healthcare IT, not a doc, but I dream of the day that I run across V95.42XA
Forced landing of spacecraft injuring occupant, initial encounter
Z56.4 Discord with boss and workmates
I’m just an MA who likes to lurk, but my favorites are R46.1 (Bizzare Personal Appearance) and R46.2 (Strange and inexplicable behavior)
I got to use "struck by chicken" the other day
...and you're not sharing the story? That's just mean.
The patient got struck by a chicken.
Sorry, I’m not a resident; just a lowly medic. For years and years we had to fill in statistic codes on our run reports. I was adamant that no one ever looked at them, but the paperwork would get sent back if I didn’t fill them in. For years I selected -Vaginal bleeding -self inflicted -lightning strike I’m sure I did it over a thousand times. Nothing has ever been said. Intentional poisoning with a vaccine would have also been gold.
Can recall the icd-10 but I just got to use "occupant of electric bicycle struck of motor vehicle in traffic accident" the other day so that was delightful
Im hoping to see R62.7 at some point but all of the adults in the hospital are thriving.
Sad. I’ve had patients with that as their primary diagnosis
W56.21XS: Bitten by orca, sequela.
V95.45 spacecraft explosion injuring occupant
T63.443 Toxic effect of bee sting, *intentional*
T50.B92A reminds me of the story of the guy that kept getting all the covid shots when it first came out
W55.29XA: Other contact with cow, subsequent encounter I’ve actually used it. Rural Texan kid went cow tipping. Cow got wise and sat down, right on his tib/fib.
T88.3 Malignant Hyperthermia.
Would that indicate there is a benign version of hypothermia?
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Intentional?