Monday, September 19, 2011

ICD-10 Codes: "Drowning and submersion due to falling or jumping from burning water-skis"


The Centers for Medicare and Medicaid Services [CMS] have just released the updated version of the medical coders’ bible, the International Classification of Disease, 10th Revison [ICD-10]. The long-awaited revision is much more detailed than previous versions, going from 18,000 codes in ICD-9 to 140,000 codes in the new release.

In an attempt to achieve greater specificity for describing diseases and injuries, the authors came up with some curious items. There are probably some other howlers, but so far, the winner is “V9027XA Drowning and submersion due to falling or jumping from burning water-skis, initial encounter.” There are also codes for subsequent encounters and sequela of drowning and submersion due to falling or jumping from burning water-skis.

I have been wracking my brain all weekend to come up with a plausible scenario in which a person could drown and  be submerged while falling or jumping from burning water-skis.

Can water-skis be set afire? It’s hard to say. According to Trails.com, they are most commonly made of a combination of fiberglass and graphite. I suppose they could be burn under certain conditions but I really don’t see how they could be ignited during normal use because, of course, they would be in the water.

One way that I could envision anyone falling or jumping from burning water skis is if that person were to water-ski through a burning oil slick. And even then, it’s hard to see how the skis would catch fire as the skier would be moving fairly quickly. Furthermore, why would one deliberately water-ski through a burning oil slick? Not only would he have to fall or jump off, he would also have to drown and be submerged.

I have come up with an answer. Someone, possibly an actor from the Jackass series of movies, sets up his water skis on milk crates in the back yard. The skis are positioned over a kiddie pool. He mounts the water skis while an accomplice sprays them with gasoline. The skis are lit, and the man jumps or falls from the burning skis, submerging and drowning himself in the process. Luckily there is an ICD-10 code for that.

While we’re on the subject, how does one have subsequent visits after drowning? Once one drowns, he is dead. I believe charging for subsequent visits would possibly be considered fraud. The only sequela of drowning that I am aware of is a funeral.

I wonder if there are codes for jumping or falling from burning snow skis?


12 comments:

Ken & Carol said...

In the north, one water skis in the summer in the water. Otherwise one just skis. In the south, one snow skis in the winter. Otherwise one just skis.

Obsinguod said...

Yes, clearly the coding calls out cases where burning water-skis (not bare burning feet) are preventing submersion. Otherwise it's just igniting the skis on spillways separating lakes and bailing under condominium docks; a perfectly normal rocket malfunction; or using water-skis on heavy crude in a tanker or sewage in a sludge spillway without encumbrance. When it comes to pass that the compressed air aiding in floating the skis is too dry or full of VOC fumes, the skis generally are on fire... Three boroughs in the NYC subway recently flooded, and with ingenuity someone could have skied in an artificial pocket of air....

I do not imagine there is a code for mental distress caused by intrinsic safety compliance? There you go.

Ian Holmes said...

It probably has something to do with this: http://www.youtube.com/watch?v=MDthMGtZKa4

Skeptical Scalpel said...

Thanks for the comments. If anyone can explain what @Obsinguod said, I would appreciate it.

Colleen Mathias, Medical Practice Administrator said...

The International Classification of Diseases (ICD) is the classification used to code and classify mortality data from death certificates as well as inpatient and outpatient coding(explains the coding after drowning).

“V9027XA Drowning and submersion due to falling or jumping from burning water-skis" is undoubtedly ridiculous, but have you ever looked at the current ICD-9-CM's section of "E" codes? There is one there for "struck accidently by lamp post" - E917.8.

I also have no idea what on earth @Obsinguod is saying.

Skeptical Scalpel said...

@Colleen

Thanks for commenting. There all also codes for burning kayaks and crushed water skis. I don't get how you can have subsequent visits if you have drowned.

Anonymous said...

PLEEEEZE!!! ... somebody figure out the name of the person who though of this and disseminate their identity throughout the universe as the poster boy/girl for repealing this hideous piece excrement "legislation" AKA "ACA".

Skeptical Scalpel said...

Anon, the ACA and the ICD-10 codes came about in different ways at different times. I just wrote a new post about this today. Here is the link http://is.gd/hrhkRj.

Anonymous said...

It is possible for a person to drown and then be resuscitated via CPR. This would make it possible for a single person to undergo this unfortunate event multiple times though it is even more perplexing why someone who had this happen to them once would ever put themselves in a similar situation for it to happen again.

Skeptical Scalpel said...

I was using the strict definition of drowning, which is "suffocation and death resulting from filling of the lungs with water or other substance."

Some experts define drowning as "the process of experiencing respiratory impairment from submersion/immersion in liquid. Furthermore, drowning outcomes should be classified as: death, morbidity, and no morbidity."

Either way, I doubt that anyone has ever drowned after falling from burning water skis once. If you know of a case, please send me a link to the story and I'll retract this post.

Bob Pratt said...

"Some Experts" are the W.H.O.
Your 'strict definition' is fraught with problems: There are >30 adjectives used for drowning scenarios: wet drowning, dry drowning, near drowning, secondary drowning, parking lot drowning etc....
Until we all embrace the W.H.O. definition we will not be collecting meaningful data.
While on the subject, we need to include deaths that occur more than 24 hours after submersion as well as boating and vehicular accidents where the victims drown. It's likely that drowning is the leading cause of death worldwide.
I'm fairly sure if someone ever does die after falling (jumping) from a burning water ski that there will be a you-tube video of it. ;-)

Skeptical Scalpel said...

Bob, you are right about the definition. I still can't figure out how one could ignite water skis. They would be wet, and the way they are finished does not seem to easily allow for combustion.

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