Hurt by a spaceship or a parrot? The remarkably specific new insurance billing codes

Hospitals and doctors use a system of about 18,000 codes to describe medical services in bills they send to insurers. Apparently, these don’t allow for enough nuance. So a new version is in the works, the ICD-10, that will expand the number to around 140,000. The additional detail is intended to give insight into ways to reduce costs or improve the quality of care. Thus, for example, instead of a single code for accidental injury involving a spaceship, there are now dozens of more specific codes, including these:

You can see how this might enhance the care you’ll receive after a saucer crashes or a loved one returns from an alien abduction. If you spend a few minutes with the new searchable database, which is endlessly entertaining, you will see that others will benefit as well. A search for “struck by,” for example, yields 13+ pages of entries including my personal favorites:

W59.22XA  —  Struck by turtle, initial encounter
W61.32XA  —  Struck by chicken, initial encounter
W61.62XA  —  Struck by duck, initial encounter
W61.52XA  —  Struck by goose, initial encounter

Each such entry is subdivided three times. Following “struck by duck: initial encounter,” for example, you’ll find “struck by duck: subsequent encounter,” followed by “struck by duck: sequela.” (Ducks are quite persistent, it seems.) There’s also struck by dolphin, parrot, cow, horse, pig, raccoon, sea lion, nonvenomous lizard, etc., each with its own set of three variations.

As useful as these new categories will surely be in caring for the vast numbers of people struck by wildlife and other things, there’s an arbitrariness to them that is upsetting to the logical mind. There is no “struck by swan,” for example, even though nesting swans are known to be more aggressive than ducks. [1] Then there are those classifications that are too specific. Is there a meaningful difference between the initial and the subsequent encounter with a duck? And would it not have sufficed to have the single category “struck by water fowl”? Because if there is a medically meaningful distinction between being struck by duck and struck by goose, what could it be? Other classifications seem too general. Take “struck by chicken,” for example. I was last struck by a chicken while digging around in the overhead freezer for the leftover lasagne. It raised a knot on my head. But I find no entry for “struck by frozen chicken,” even though it causes an altogether different kind of injury than the more run-of-the-mill chicken strike. So I hope that the draftsmen of the ICD-10 will remain open to making further refinements as they receive constructive feedback such as this.

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Footnote [1]: “Every young man starting life should know how to cope with an angry swan, so I will briefly relate the proper procedure. You begin by picking up the raincoat which somebody has dropped; and then, judging the distance to a nicety, you simply shove the raincoat over the bird’s head; and, taking the boat-hook which you have prudently brought with you, you insert it under the swan and heave. […] That was Jeeves’s method, and I cannot see how it could be improved upon.” P.G. Wodehouse, Clustering ‘Round Young Bingo.