Home Columns A STATE OF MIND: It’s WHO’s Move



by Larry Floersch

The latest issue of my favorite weekly science magazine had an article on some of the latest ICD codes developed by the World Health Organization (WHO). As we all know from our advanced placement pre-med classes in high school, “ICD” stands for the “International Classification of Diseases.” Now in its tenth revision, the codes in the ICD are used by doctors to designate a diagnosis from an elaborate list of diseases and injuries, because, as you are well aware, doctors have notoriously bad handwriting and reading a badly scribbled code is easier than reading a badly scribbled “transsphenoidal hypophysectomy.”

Exactly how patients might have come by some of the injuries listed in the ICD is hard to explain. For instance, the description for code W55.21 is, and I’m not making this up, “bitten by cow.” Having written in these pages about the hidden intelligence of cows and possible willful aspects of their behavior, I can understand that a cow might want to bite someone, but the fact that cows lack upper incisors makes the mechanics of such an act difficult. They can’t exactly sneak up and nip you on the ankle like, say, one of those malicious little wiener dogs.

The mishaps behind other codes are more explicable even though unusual, such as V95.40, “unspecified spacecraft accident injuring occupant” (no doubt popular in Area 51); V97.33, “sucked into jet engine” and V96.00, “unspecified balloon accident injuring occupant.” And there is W56.22, “struck by orca,” which probably doesn’t get much use in most of the 48 states. One of my favorites is V91.07, and again, I’m not making this up, “burn due to water-skis on fire.” How water skis catch fire while in use escapes me, as does why the user of the skis wouldn’t just fall in the water to avoid being burned.

Even though these new codes just went into effect back in October of 2015, I am here to tell you that they are already out of date. I base this on a scientific analysis of the codes I performed myself using some recent news reports concerning the activity of burglars in our country. I won’t bore you with all the science stuff. Quite simply, I tried to find codes that would be appropriate for injuries these burglars suffered on the job and discovered holes in the ICD system so large you could easily jump through them on flaming water skis.

The most recent of these burglar reports came from — need I say more? — California. The police reported that a young man broke into a house and stole a purse. He then jumped into an SUV and drove away, in the process hitting the purse owner’s boyfriend, who apparently was in close pursuit. The police caught the burglar a short distance away. They are still puzzled about why the burglar was totally naked on a night where the temperature hovered around 30 degrees.

Because the burglar struck the boyfriend with his SUV (even though the boyfriend was not badly hurt and refused medical treatment), his bail was set at $250,000 for assault with a deadly weapon. I am making the assumption he is still in jail for lack of bail because he could not have had his wallet on him.

Given the cold temperatures on the evening of his crime spree, this burglar might have suffered mild hypothermia (ICD code T68.XX). Unfortunately, the ICD code list does not break down hypothermia any further, such as “hypothermia from extensive skin contact with cold Naugahyde upholstery of getaway vehicle,” and therefore is completely inadequate.

And then there is the case of a 22-year-old burglar in Palm Bay, Florida. Local residents noticed the young man and an accomplice lurking around neighborhood houses and called the police. When the police arrived on the scene, the two would-be burglars attempted to hide. This one selected a spot in the bushes by a lake behind the houses he was casing.

The police did eventually find him, but it was three days later, after he was reported missing. His body was in the lake.

This is another case where the ICD code system falls short. W58.01, “bitten by alligator,” which the burglar certainly was, doesn’t quite cover it because the guy was also drowned by the alligator and the alligator had started to snack on him. W69.XX, “accidental drowning and submersion while in natural water,” is close, because he was in a lake, but it makes no mention of alligators. W73.XX, “other specified cause of accidental non-transport drowning and submersion,” might work. But both W69.XX and W73.XX are for “accidental” drowning, and in this case the alligator intended to do exactly what it did. There was nothing accidental about it. This young man simply forgot some basics that anyone who lives in Florida knows: (a) Florida has so many ‘gators that they have named the sports teams of one of their major universities after them; (b) some alligators live in lakes; and (c) some residents of Florida make a habit of feeding alligators things like whole raw chickens, as if the gators were large scaly songbirds in the back yard. This, of course, convinces the alligators that humans are a good source of nutrition.

The third case of burglary is pertinent to the Christmas season just passed. Once again in California, a young man was burglarizing a house. The news report did not say whether the burglar had used the chimney to gain access to the house, but nevertheless, he became stuck while attempting to climb up the chimney.

Upon returning home, the homeowner, unaware the burglar was in the chimney, built a fire in the fireplace. The burglar, who had no doubt remained silent to that point to avoid detection, began yelling. Because the burglar blocked the flue and therefore disturbed the draft, smoke filled the house. The homeowner immediately extinguished the fire and called the fire department. On arrival, the fire department team had to demolish the back of the brick fireplace and chimney to get to the burglar, but by then the smoke and flames had done their job.

It being the Christmas season and all, had the burglar only remembered the simple trick of laying a finger aside of the nose and giving a nod he may have escaped without a scratch.

Alas, once again the ICD system does not have a code to fit. T30.0, “Burn of unspecified body region, unspecified degree,” is not specific enough. X02.0X, “exposure to flames in controlled fire in building or structure,” explains the burns from the controlled fire in the fireplace, but doesn’t cover the smoke inhalation or mention the chimney, and X02.1X, “exposure to smoke in controlled fire in building or structure,” doesn’t cover the flames or chimney.

So it’s back to the drawing board WHO. Let’s get working on the eleventh revision of the ICD codes. If you have a code to cover a burn from flaming water skis, you should be able to do better by these burglars.