Depending upon your political persuasion, the subject of this post might make you angry, or it might make you despair, but for me, it just made me laugh. It is about healthcare, health insurance and about a particularly arcane involvement of our federal government in these two industries. I should probably go on record that I support President Obama’s healthcare bill. A hot-button political issue to be sure. I was led to this topic by Anna Mathews’ Marketplace interview and her Wall Street Journal article on the subject. MS. Mathews’ covers in her article the expected (2013) introduction of the ICD-10 codes. ICD-10 stands for International Classification of Diseases, 10th Revision. These ICD codes are to the medical world what the Dewey decimal system is to a library. Healthcare organizations, like your doctor’s practice, use these codes to communicate with your health insurance company. These codes explain why you visited the doctor, why your doctor proscribed the tests and treatments performed and most importantly, why your insurance company should pay for it all.

ICD-10 codes, please, you must be thinking, can’t you come up with anything more interesting than that? Come, come, dear readers please don’t despair, but just keep reading on. In the 10th revision of the ICD the number of codes will balloon from 18,000 to about 140,000. The intention of this increase is to more closely define a particular patient’s ailment. For example, in the ICD-9 code your doctor might simply report that you were treated for a broken bone. In the ICD-10 code that one entry has been expanded to 2,595 separate ones, one for each bone in the human body, plus some other multiplier. I’m an engineer, so I believe having more data is a good thing, but as with any good intention, there are always unintended consequences. Mathews’ ably covers these unintentionally funny, good intentions. Here are a few examples:

• W61.11XA – a code for “injuries related to macaws”
• W22.02XA – “walked into lamppost, initial encounter”, and when at first you do not succeed, try, try again, W22.02XD – “walked into lamppost, subsequent encounter”
• V91.07XA – “burn due to water-skis on fire”, possibly work related, for trick skiers who use fiery hoops?

There may be some gamesmanship incorporated into the ICD-10 codes. Mathews’ even offers a few suspects, involving sex change. Some codes will inevitably confer a certain stigma. Disease has always been capable of doing this, even back to mediaeval times when disease was equated with sin. The purpose of these codes is to allow the caregiver to communicate with the insurance company; some codes will become more valuable than others. A bad code could cause poor coverage. On the other hand, a code of W22.02XD versus W22.02XA could indicate a more serious problem than simple carelessness. When I asked Anne to edit this post, I got more than I had bargined for, in the form of an editorial response. What do you think?