Injured In a Chicken Coop While Playing a Brass Instrument and You Have a Bizarre Personal Appearance? There are Federally Mandated Medical Billing Codes For That.


They're going to need a lot of codes to describe this one.

Until recently, the federally designed Internal Classification of Diseases included about 18,000 medical classification codes for health providers to use during the billing process. An updated version of system has…a few more. Via The Wall Street Journal:

A new federally mandated version will expand the number to around 140,000—adding codes that describe precisely what bone was broken, or which artery is receiving a stent.

It will also have a code for recording that a patient's injury occurred in a chicken coop. (See code.)

Indeed, health plans may never again wonder where a patient got hurt. There are codes for injuries in opera houses (see code), art galleries (see code), squash courts (see code) and nine locations in and around a mobile home (see codes), from the bathroom to the bedroom.

…Some codes could seem downright insulting: R46.1 is "bizarre personal appearance (see code)," while R46.0 is "very low level of personal hygiene (see code)."

It's not clear how many klutzes want to notify their insurers that a doctor visit was a W22.02XA, "walked into lamppost, initial encounter" (or, for that matter, a W22.02XD, "walked into lamppost, subsequent encounter").

Why are there codes for injuries received while sewing, ironing, playing a brass instrument, crocheting, doing handcrafts, or knitting—but not while shopping, wonders Rhonda Buckholtz, who does ICD-10 training for the American Academy of Professional Coders, a credentialing organization.

Well, you can't say it's not thorough. Complete article here


NEXT: Abduction

Editor's Note: We invite comments and request that they be civil and on-topic. We do not moderate or assume any responsibility for comments, which are owned by the readers who post them. Comments do not represent the views of Reason.com or Reason Foundation. We reserve the right to delete any comment for any reason at any time. Report abuses.

  1. My oldest brother is a medical doctor. During a recent summer vacation, I asked him about the amount of paperwork he has to fill out.

    He kind of laughed and said most of the doctors at the hospital just put in any short gibberish they want, knowing the chances of it actually being read is close to zero. And if something does come back a year later, how could you even remember what you wrote and why?

  2. This is a joke, right? Good, cause I need a laugh today!

  3. This is generating a HUGE amount of work in the healthcare IT business. It’s like Y2K plus Sarbanes Oxley combined. Just say “ICD-10” and watch the pained expressions. Jobs created and/or saved, I guess.

  4. How can you have a rational medical coding system natural rights political expression freedom health if it doesn’t take months to get signs things government approved pharmaceuticals approved by petty municipal bureaucrats. Waiting periods for guns, waiting periods for political lawn signs supplements if I need you to suppress them so I can take from you the fruits of your labors to give them to those who won’t labor… without nonsense like this…..its all part of making life better for the people.

    1. Why did you strike-out all that other stuff?

      1. I’m trying to work an “all-purpose” nonsensical Tony response into my repertoire. It’s still beta.

  5. Do you see, Epi? Do you see? They code injuries on a squash court…a legitimate sport, while a pickleball court is left out.

    Unless they allow it to be coded as being injured in a gay bathhouse or similar spot, NTTAWWT, but at least the lack of it being a viable athletic venue is noted by it’s conspicuous absence. 😛

    1. Do you see, Epi? Do you see?

      I just had flashbacks to Manhunter.

      1. Sounds like the Orphans trying to talk to the Warriors.

        1. “Warriors, come out and plaahyyyyeeee.”

          1. Hey Sully.. remember when I promised to kill you last?

            1. That’s right, Matrix! You did!

              1. I liiiiiied

  6. At last we now know what it is that will cause the destruction of human civilization: Codes.

    1. ZZ80962.57WV: Caught up in destruction of human civilization.

      1. ZZ80962.57WY: Caught up in destruction of human civilization, subsequent encounter

  7. Although I haven’t perused ICD-10, I can swear that there are E codes in ICD-9 for being involved with a space shuttle accident

    1. Are there codes for being struck by pieces of a falling satellite……that could be huge this weekend and I’d really like to be the first to use it.

      1. Actually I believe there are. Let me look at it at work tonight and I’ll repost. I know there are codes for being in a thermonuclear blast (terrorist) and being in a thermonuclear event (non-terrorist). Hit by aircraft as part of terrorism is in there too. It would be comical if there weren’t people employed by the hospital to figure out exactly which code should be used.

    2. I remember flipping through an ICD-9 manual and seeing just that. There were a half dozen or so different codes dealing with spacecraft related injuries and I just thought to myself, “how often have these ever been used?”

      1. If we can’t classify it, then we can’t track it, now can we?


      1. They feel the need to be that detailed in generating the codes but they can’t afford to write at words at full length?

        I suppose the abbreviation are historical and will never go away, but I don’t have to like it.

  8. This is generating a HUGE amount of busywork in the healthcare IT business. It’s like Y2K plus Sarbanes Oxley combined. Just say “ICD-10” and watch the pained expressions. Jobs created and/or saved, I guess.


  9. E840-845 to be exact

  10. ER CLERICAL: “I’m sorry, ma’am, we won’t be able to admit you until we select the right code. Now, did you say you were INSIDE the brass instrument, or that the brass instrument was ON you, or….?”

    PATIENT: glurjka,mpknndj

    ER CLERICAL: I’m sorry, you’ll have to speak more clearly, ma’am.


    ER CLERICAL: Ma’am!

    PATIENT: *expires*

    ER CLERICAL: Ohhhh, that’s too bad! Well, at least it will save some paperwork. Now, where’s that code for “Died On A Gurney In The ER….?”

    1. If it was inside the patient, my money would be on a woodwind.

        1. Meh, I can Roll With It.

      1. What’s the code for “band camp?”

  11. This is the real [JOBZ] plan.

    Mountains upon mountains of busywork, far as the eye can see, so that the number of broken left arms suffered by unhygienic persons whilst locked up in chicken coops by the Phantom of the Opera can be sufficiently forecasted, and planned for..

    1. and planned for..

      and regulated or outlawed out of existence.

      ‘so we’ve noticed a spike in motorcycle, gun, sports, etc activity. Therefore we need helmets, pads, bans, etc in order to reduce health-care costs.

  12. After further review, it seems apparent that santorum is not dangerous.

    1. It can be if it’s not cleaned up right away, especially if oil-based lubricants are involved.

  13. I looked for anal rape, but it isn’t in there.

    Perhaps if I try the Internal Revenue Code…

    1. You should see that reference on each and every one of the 75,000 pages.

    2. Perhaps if I try the Internal Revenue Code…

      I don’t know if they have any codes for that, but I hear they are the authority on it.

  14. From my complete outsider’s perspective, my guess would be that this is an attempt to increase the complexity of coding past the capacity of current software to code without human intervention or assistance.

    To make sure [JOBZ] are not lost to automation, just dial up the job requirements beyond the specs of the most effective automated solution currently available.

  15. Brazziiiiiillllll……..

    1. I can see it now: “Oh no, dearie, those medical gift tokens cover W5611XA, ‘bitten by sea lion, initial encounter’, but you were bitten by a [i]seal[/i], which would be a W5631XA, ‘bitten by other marine mammal, initial encounter’.”

      I also have to note, just for the bizarreness, that there’s a “V203XXA
      Person boarding or alighting a motorcycle injured in collision with pedestrian or animal, initial encounter” which is distinct from if you were actually [i]driving[/i] or a passenger on the motorcycle. How the flying hell you have a collision with a pedestrian or animal while you are in the process of getting on or off a motorcycle, and what differentiates that from, say, “W5522XA
      Struck by cow, initial encounter”, is beyond me, but I guess that’s the kind of thing you have to be a doctor or insurance company bureaucrat to know.

      1. W5522XA Struck by cow, initial encounter

        This one actually happened to me, although I was uninjured.

        Wait, I guess technically it was a bull, not a cow. Is that separate?

  16. Dean Jones: I’ve been reviewing Darren’s internship journal. Doing laundry?

    Kramer: ?Yeah.

    Dean Jones: ?mending chicken wire, high tea with a Mr. Newman?

    Kramer: I know it sounds pretty glamorous, but it’s business as usual at Kramerica.

    Dean Jones: As far as I can tell your entire enterprise is more than a solitary man with a messy apartment which may or may not contain a chicken.

    Kramer: And with Darren’s help, we’ll get that chicken.

    Dean Jones: I’m sorry, but we can’t allow Darren to continue working with you.

    Kramer: Well, I have to say this seems capricious and arbitrary.

    Dean Jones: Your fly is open.

    1. As far as I can tell your entire enterprise is no more than a solitary man with a messy apartment which may or may not contain a chicken.

      1. That was put in there on purpose to see who would actually bother to read the whole thing. Consider yourself snared.

  17. Good freaking dog! Welcome to information science circa 1900. This is simply a jobs act for the walking retarded. Unbelievable.

  18. That was really an Onion article, right?

  19. Your first clue that this here post is off base is calling the ICD the INTERNAL classification of disease rather than INTERNATIONAL. In fact, the original point of the ICD was to develop a worldwide standard with which researchers could compare disease incidence. In its first incarnations it covered only infectious and chronic diseases; I hope even the most ardent libertarians will recognize the usefulness of having a standard system, even if it did spring forth from beauracracy. In later versions the ICD they have indeed added injuries, poisoning, and other externally caused maladies to the list. But let’s be clear – the ICD was developed by WHO, not the feds, and it was developed to enable research rather than billing. What the article says is that the feds have tacked on fine-grained codes for their own purposes. Please, ridicule that to your heart’s content, but don’t comment out of ignorance and let’s please not throw the baby out with the bathwater.

    1. I hope even the most ardent libertarians will recognize the usefulness of having a standard system….

      Useful or not mockery is what we do here!

    2. The first clue that this here post is off base is the whiny Internal/International criticism for someone who then mangles the spelling of “bureaucracy”.

      Fucking spell check, how does it work?

      1. zing. but no substantive response.

      2. ’nuff said.

    3. I think everyone gets that the govt’s purpose for using these codes is “research” into more ways to micro-manage every single aspect of your life — after all, it can now be quantified. Burning water skis, indeed.

      1. Hmmm… let’s say I had a burning desire to prove that smoking pot not only doesn’t cause cancer, but it prevents it. To accomplish this study I need to collect cancer data from the Netherlands, Japan, Israel, and the US. Should I forgo the codes and hire translators in three languages? Or should I use an internationally recognized coding system developed to facilitate research done by any entity, private or public?

        1. “says” pot smoking CAUSES cancer — justification to bust down your door?

          1. Hardly scientists’ fault that politicians like to misuse the data. Note that MJ was illegalized long before anyone suspected smoking tobacco caused cancer. For that matter, alcohol causes cancer, but politicians aren’t using that fact to call for its reillegalization. So is your point that scientists should just not study anything lest the knowledge be misused? Yeah man, fuck that enlightenment shit.

    4. “What the article says is that the feds have tacked on fine-grained codes for their own purposes. Please, ridicule that to your heart’s content”

      Uh, yes, that seems to be the point of the post and most of the comments.

      1. All I am saying is that there is, was, and always shall be a very good rationale for having an ICD system. It is very useful and has contributed to humanity’s betterment for decades. The recent addition of picayune billing codes does not invalidate the entire enterprise.

        But yeah I realize people come here to make funny jokes.

        1. I actually agree with you that there is a good rationale for having a standard reporting method. If done right, it would greatly simplify the collection and comparison of information. But adding a separate code for injury to every single finger (“S60427A Blister (nonthermal) of left little finger, initial encounter”) and the thumb, as well as a code for an unspecified finger, as well as a code for an “other” finger (?!), as well as a code for the hand, seems to take us out of the “useful information” sphere and into the “too specific to be useful” sphere. The more codes you have, the more likely someone is to just grumble and write down “burn, unspecified” instead of “burn of first degree of left elbow”.

          1. What? How will masters’ candidates write theses without being able to compare thermal and non-thermal blisters of the left index finger above the first knuckle? Seriously, I could whack out a GIS thesis tomorrow on something like this (well, okay, it would take me about six weeks to get it written, sourced and formatted, but I could be comparing and contrasting rural and urban Florida with a map inside of 2 weeks)

        2. This article is just yet another example of how government can take something good and misuse it. Does it truly upset you so much to see that pointed out?

    5. Yeah, but most of us also realize that, like recyclying, the work is being forced onto people “for their own good”.

      Also the data is being gathered by a bunch of doctors who don’t give a fuck if the exact, 100% correct billing code is entered as long as its close.

      Guy cuts off his finger, you put in the code for the treatment you gave him, who gives a fuck if it was cut off in a chickencoop on the ISS or somewhere else.

  20. R46.0 is “very low level of personal hygiene

    Oh, dear Zod, my grandmother was right: you must ALWAYS wear clean hole-less underwear, because if you have an accident and need to go the the emergency room and the doctors see you have dirty underwear, you’ll die because medical personnel will be too busy holding their noses and saying “pee-yew” to bother saving you.

  21. Here are a few of the more arcane codes:
    T84061A: Mauled by bear, initial encounter
    F34912RRRRRR: Pirate attack, initial encounter
    L17792T: Accidental malfunction of ninja throwing star, subsequent encounter
    F87712F: Fusili statuette in overlapping sites of rectum, anus and anal canal

  22. Are there different codes for repetitive stress injury to the hand, depending on what you were doing with it?

    1. The would be the fap series of the code.

  23. Full list, searching for “spacecraft”

    V9540XA Unspecified spacecraft accident injuring occupant, initial encounter
    V9540XD Unspecified spacecraft accident injuring occupant, subsequent encounter
    V9540XS Unspecified spacecraft accident injuring occupant, sequela
    V9541XA Spacecraft crash injuring occupant, initial encounter
    V9541XD Spacecraft crash injuring occupant, subsequent encounter
    V9541XS Spacecraft crash injuring occupant, sequela
    V9542XA Forced landing of spacecraft injuring occupant, initial encounter
    V9542XD Forced landing of spacecraft injuring occupant, subsequent encounter
    V9542XS Forced landing of spacecraft injuring occupant, sequela
    V9543XA Spacecraft collision injuring occupant, initial encounter
    V9543XD Spacecraft collision injuring occupant, subsequent encounter
    V9543XS Spacecraft collision injuring occupant, sequela
    V9544XA Spacecraft fire injuring occupant, initial encounter
    V9544XD Spacecraft fire injuring occupant, subsequent encounter
    V9544XS Spacecraft fire injuring occupant, sequela
    V9545XA Spacecraft explosion injuring occupant, initial encounter
    V9545XD Spacecraft explosion injuring occupant, subsequent encounter
    V9545XS Spacecraft explosion injuring occupant, sequela
    V9549XA Other spacecraft accident injuring occupant, initial encounter
    V9549XD Other spacecraft accident injuring occupant, subsequent encounter
    V9549XS Other spacecraft accident injuring occupant, sequela

    1. I guess ‘unspecified’ can mean flying saucers. Are there any codes for unknown medical procedures involving such?

  24. V9344XD Struck by falling object on sailboat, subsequent encounter

    Really, a subsequent encounter?

    1. Subsequent applies to the doctor’s visit, not the incident.

      1. Ah, I see JD commented on that below.

  25. This is great stuff. I am trying to envision a situation in which one might apply “V0501XA Pedestrian on roller-skates injured in collision with railway train or railway vehicle in nontraffic accident, initial encounter”. I am only saddened that there is no specific code for “collision between pedestrian on roller-skates and aircraft”.

    1. Also, I am scratching my head at this one: “X831XXD Intentional self-harm by electrocution, subsequent encounter”? One generally doesn’t have a “subsequent encounter” after electrocution…

      1. One generally doesnt have a susequent encounter with a spacecraft explosion either.


        1. In all seriousness, “subsequent encounter” seems to mean “seeing the doctor again“, not “encountering the exploding spacecraft/burning water-ski/lamppost/parrot” again. You could see the doctor more than once after you were injured by the spacecraft explosion, but if you’re electrocuted I think you generally only see the doctor once, after which the mortician will take over.

          1. Okay, that makes a lot more sense.

            And yeah, electrocution is clearly one time only.

          2. However, that ruins my Nagasaki joke below.

          3. Then again, who knows?
            “S060X7A Concussion with loss of consciousness of any duration with death due to brain injury prior to regaining consciousness, initial encounter”

            So apparently you can be dead and still go back to see the doctor.

        2. Pretty sure the encounter part refers to the encounter between the patient and provider, as in “initial treatment” or “subsequent treatment”. Just guessing.

          1. Darn, too slow. Must hit refresh more often.

    2. I think this is really going to raise the bar for those who want to commit entertaining suicides.

      “There ain’t no code for it? Then roller skating on the tarmac at LAX it is. Good-by cruel world!”

  26. V9027XD Drowning and submersion due to falling or jumping from burning water-skis, subsequent encounter

    1. Is there a code for “jumping the shark” ala Fonzi style?

      HP342FONZ – jumping the shark water skis with a leather jacket

  27. S30866A Insect bite (nonvenomous) of unspecified external genital organs, female, initial encounter

  28. T63112D Toxic effect of venom of gila monster, intentional self-harm, subsequent encounter

    1. Now don’t lie. You were looking up “mons,” same as me. Weren’t you, you sick, twisted man.

      1. Nope. “venom”

        1. Oh. I guess I’m the only sick fuck that searched mons, which is well depicted in Wikipedia, I might add.

      2. I’m not going to search, but how many hits for ‘taint’?

        1. At least one that I’m aware of.

    2. The necessity for this code was apparently foreseen over 100 years ago.
      “I have never been called to attend a case of Gila monster bite, and I don’t want to be. I think a man who is fool enough to get bitten by a Gila monster ought to die. The creature is so sluggish and slow of movement that the victim of its bite is compelled to help largely in order to get bitten.”
      ?Dr. Ward, Arizona Graphic, September 23, 1899

      (Thank you, Wikipedia.)

  29. Y36121D War operations involving destruction of aircraft due to collision with other aircraft, civilian, subsequent encounter

    New rule: Any civilian who has survived an airplane to airplane crash during war operations is never allowed to board a plane during war operations again.

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

    I survived Hiroshima and decided, you know where will be safe? Nagasaki.

    1. Yeah, you joke, but:

      On 6 August 1945, he was in Hiroshima, preparing to return home from a business trip when the American B-29 bomber, the Enola Gay, dropped an atomic bomb on the city. Yamaguchi lived, while 140,000 other people who were in the city that morning died, some in an agonising instant, others many months later.

      Burned and barely able to comprehend what had happened – only that he had witnessed a bomb unlike any used before – Yamaguchi spent a fitful night in an air raid shelter before returning home the following day.

      That home, 180 miles to the west, was Nagasaki.


      1. I made the joke wondering who the fuck it actually happened to.

        I figured there was one. Ugh, that blows.

      2. Lucky Yamaguchi!!

        I remember reading about him a few months ago.

  31. What’s the difference in K622 Anal Prolapse and K623 Rectal Prolapse?

    1. About an inch and a half.

        1. Thank you, I’m here all week…..don’t forget to tip your cocktail waitress.

  32. Rhonda Buckholtz, who does ICD-10 training for the American Academy of Professional Coders, a credentialing organization.

    Take me now, Lord….

  33. As for “spacecraft” catastrophes resulting in classifiable injuries, I’m hoping for the day the launch vehicle rises slowly a few feet, gracefully turns and, to the oohs and ahhs of the assembled dignitaries, proceeds to fly at turtle-top level toward the VIP grandstand.

    1. We have a code for that.

      1. Yeah that would be irony.

  34. This is where the need for the “injured while playing a brass instrument” code started…

  35. So is it “Grandma got W5532XA, struck by other hoof stock, initial encounter, walking home from our house Christmas Eve” or “Grandma got V0610XA, Pedestrian on foot injured in collision with other nonmotor vehicle in traffic accident, initial encounter, walking home from our house Christmas Eve”? Presumably reindeer are ‘hoof stock’, but if they’re hitched to a sleigh, I guess it’s a ‘nonmotor vehicle’…I can’t find a code specifically relating to animal-drawn vehicles.

  36. Some places are not “tight” on their coding. Making it more complicated just means finding work arounds. In that way, the coding may become less accurate.

  37. “”Indeed, health plans may never again wonder where a patient got hurt.””

    I’m wondering if this paves the way for risk based insurance. If you didn’t declare water ski as one of your activities, and you are hurt water sking, claim denied.

  38. Why are there codes for injuries received while sewing, ironing, playing a brass instrument, crocheting, doing handcrafts, or knitting

    Two reasons: 1) they need to know what to outlaw/highly regulate next, and 2) this is their way of “creating jobs”. They make up nonsense shit to do which necessitates hiring people to do this nonsense so that you, as a medical practitioner, don’t go to jail.

    1. Frankly, I believe that’s the real point of this: to continue to push for doctors and other healthcare providers to join large groups, which are more easily controlled. The solo practitioner and small group practices are going away, replaced by large health organization. Small operations can’t afford to employ several coders to decipher all this gibberish.

Please to post comments

Comments are closed.