Under My Skin

Prepare for ICD-10!


As the date for implementing ICD-10 gets closer, consulting firms send daily offers to help us adapt to the new diagnostic regime. As a service to the profession, Under My Skin will provide periodic updates to save you consulting fees.

In an earlier column, you learned about new codes like injury from burning water skis. We also covered codes for envenomation by Gila monsters, both unintentional and intentional. You should know that these are already available under ICD-9. No need to wait till next year to use them!

ICD-9-CM E905.0: Venomous snakes and lizards causing poisoning and toxic reactions. These include the following: cobra, copperhead snake, coral snake, fer-de-lance snake, Gila monster, krait, mamba, viper, and several others. Do NOT use this code for bites by nonvenomous snakes and lizards. (That may come back to bite you ... Sorry!)

Anyone who can define a fer-de-lance or a krait is gets extra credit (but no extra payment). If you can either identify a mamba, or dance it, good for you!

ICD-10 naturally amplifies this inadequate taxonomy:

• T63.111 – Toxic effect of venom of Gila monster, accidental (unintentional)

• T63.112 – Toxic effect of venom of Gila monster, intentional (self-harm)

• T63.113 – Toxic effect of venom of Gila monster, assault

• T63.114 – Toxic effect of venom of Gila monster, undetermined

Questions: For the new "assault" code, was the Gila monster the assailant or was its owner? Does "undetermined" mean you don’t really know how you got bitten (come on, was that really an accident – weren’t you petting the Gila kind of roughly?) or that you didn’t determine whether it actually was a Gila monster (because it ran away so fast that that it could have been a marmoset).

There are other ICD-9 codes you can already use (right now!) I recently got a 6-page EMR from a referring clinic (you get those, don’t you?) listing one of the patient’s 14 diagnoses as E968.2: Assault by striking by blunt or thrown object.

This opened my eyes to:

• E968.5 – Assault by transport vehicle.

• E968.3 – Assault by hot liquid.

• E968.1 – Assault by pushing from a high place. (Questions: How high? How hot? Transporting what?)

While on the subject of injuries in high places, you might consider:

• E840.1 – Accident by powered aircraft at takeoff or landing.

Again, ICD-10 will be more comprehensive.

Looking at injury from burning water skis, we find:

• V91.07 – Burn due to water-skis on fire.

Within which are:

• V91.07XA ... initial encounter.

• V91.07XD ... subsequent encounter.

• V91.07XS ... sequela.

This is not all! V91.07 has many other subcategories:

• V91.0 – Burn due to watercraft on fire.

• V91.01 – Burn due to passenger ship on fire.

• V91.02 – Burn due to fishing boat on fire.

• V91.05 – Burn due to canoe or kayak on fire.

But wait! There is also V91.1 – Crushed between watercraft and other watercraft or other object due to collision. Within which are:

• V91.10 – Crushed between merchant ship and other watercraft or other object due to collision.

• V91.12 – Crushed between fishing boat and other watercraft or other object due to collision.

• V91.15 – Crushed between canoe or kayak and other watercraft or other object due to collision.

Each of these of course includes subcodes for: initial encounter, subsequent encounter, and sequela. (Conversion hysteria caused by paranoid fear of rampaging kayaks?)

The practical advantages to learning all this extend beyond the office. Suppose you’re fishing in a rowboat on a lazy Sunday afternoon when a kayaker waving a flaming blowtorch careens toward you full tilt and you leap overboard. When the Coast Guard pulls you out, you can shout, "V91.05! V91.15!"

In our next installment, we will take up other subsets of external causes of morbidity, including:

• W20 – struck by thrown, projected, or falling object such as:

• W20.0 – Falling object in cave (initial encounter, subsequent encounter, sequela).

• W20.1 – Struck by object due to collapse of building (ditto).

• W28 – Contact with powered lawn mower.

• W60 – Contact with nonvenomous plant thorns and spines and sharp leaves.

Master these. Future columns will cover injuries caused by forces of nature, injuries caused by supernatural means (such as witchcraft, exorcism), assassination (first episode, second episode, sequela), and acute psychosis caused by marauding ICD-10 consultants.

Dr. Rockoff practices dermatology in Brookline, Mass. He is on the clinical faculty at Tufts University School of Medicine, Boston, and has taught senior medical students and other trainees for 30 years. Dr. Rockoff has contributed to the Under My Skin column in Skin & Allergy News since January 2002.

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