There seems to be some misunderstanding what is meant by "subsequent encounter" in this context. These are codes for office visits. "Subsequent encounter" means that a patient is not seeing a physician for the first time about their injury. There are also codes for "initial encounter."
So initial vs subsequent encounter are completely different codes? Wouldn't this approach double the number of codes? Why wouldn't this be some other field of data associated with the form instead of mixing it up in the diagnostic 'topic'.
Medical diagnosis codes are all about reimbursement. Doctors do not rely on coding so much as finance dept relies on coding.
Proper coding means more $$, so talented dx coders are valuable.
Separating the code this way may not make sense medically, but it makes a lot more sense when you realize CMS or Blue Cross wants more coded granularity for automatic transmission of accurate financial information.
What does this have to do with anything? Is it just to inject a bit of cynicism?
Because while there's certainly a lot to be gained by a bit of creativity with the coding, the first/subsequent encounter distinction is ill-suited, considering these are binary categories, and any mistakes/attempts to defraud can detected with an sQL query shorter than this paragraph.
Concerning the original question: it's basically denormalized, with the usual tradeoffs. I'd guess it's easier to double the number of codes than to add a new attribute to legacy systems.
Dx codes are a big part of my programming world, I work on medical software. Not trying to be cynical, just offering an insider perspective from someone who just helped hundreds of hospitals and thousands of agencies complete the ICD-10 switch seamlessly with no rejected 485s, no rejected 837I(5010)s or other payer rejections.
Not trying to be cynical, just trying to offer a view into the requirements set before me.
My understanding is that codes are simply a lookup into the structured version of the above document; they aren't "parseable" any more than an MD5 hash is parseable, but they uniquely identify a combination of conditions. As other posters have noted, the complexity required to implement that lookup table is an intentional barrier to entry.
There is a format to the code that allows any code to indicate initial vs. subsequent. It is important for looking for first visit cure vs. multiple visits to cure a condition.
Actually it's worth reminding that it's the opposite that is true. Bureaucracy, paperwork, are the only known ways to reduce gaming and enforce equal access to justice. O boy I hate paperwork, but it's there for a reason, a good reason.
Maybe that's the intention, but like code, the more complex you make e.g. tax laws, the greater chance there are loopholes (bugs). And there certainly are loopholes, if corporations' low/zero tax rates are any evidence.
It's not really equality when you raise the barriers to entry by giving larger companies an advantage when they can hire people who know how to game the rules, or who can hire lobbyists to write the rules in their favor, or get their own people into said bureaucracy (regulatory capture) and the little guys just don't have the money for any of that. You prevent people from entering the market, resulting in reduced competition.
It's okay and there is no need to be shy about making comments or voting for things. Now that finally, after all this time of being a bystander, your parent convinced you to take this step, please tell us about your story.
I just mean to say that person you thanked seemed quite emotional. And you made an account, and thanked them. But I cannot really see what's so special about money turning into more money. That's why you went to primary school. A few dollars made you able to read and write, and now you're using it to save dollars or make more dollars.
So please: expand on the emotion now you've taken the plunge.
Transparency is the only known way to enforce equal access to government services. Bureaucracy is used to thwart that, via complication that can only be unraveled by (often very highly paid) specialists.
I'm not even sure how you can state that paperwork enforces equal access to justice. It certainly isn't working in the United States, unless you know of magical paperwork that will stop cops from choking black people to death.
An initial consultation is more in-depth, as the doctor is gathering information and diagnosing, whereas subsequent consultations are more about monitoring and fine-tuning the issue. Usually they're also shorter.
Hold on, hold on: when you say 'spacecraft', do you mean complete space vehicles, which would be 336414, or space satellites, communications, which would be 334220?
I don't even... why in the world would it be important for a doctor to differentiate being struck by a dolphin or struck by orca (side note: orcas are dolphins!).
The only semi-plausible explanation is some weird insurance plan crafted for sea-world (et-al) staff. Neither Orcas nor (other) Dolphins were ever recorded to attack human beings out of captivity anyhow.
Unless an over-amorous encounter could be considered an attack. Seems to be a real problem, wonder if there's a code for 'loved to death(drowning) by dolphin'
It would be interesting to read a design document (or post-hoc technical analysis) that enumerates all the purposes that medical billing codes are used for. Maybe it would explain the easily-mocked craziness.
These are diagnosis codes, so it wraps up to national-level reporting - i.e. 35 people were injured by dolphins this year.
Also, insurance companies get crazy nit-picky with what types of treatment they'll cover for diagnoses. There is an entire industry around scrubbing claims and making sure treatment meets the diagnosis codes.
Insurance billing. These need to be exact in order to correlate to a) rates negotiated b) data collected for future underwriting c) exact repayment. Medical billing is a crazy world.
I've gotta believe that some dolphin injuries are more severe than some orca injuries.
At any rate, once the code describes a situation so specific that it may only classify a few injuries a year, what possible benefit may come from that?
So, an orca (9 codes) and a squirrel (6 codes) have their own damn codes but a friggin bear is in the other category?!? Heck, wolves, coyotes, bears, and mountain lions all don't have their own codes. I see a lobbying effort that needs to go on to show the true nature of dangerous animals in the US and quit hiding these attacks in the other category.
On the other hand, I do like the difference between cats and dogs:
W540XXA Bitten by dog, initial encounter
W540XXD Bitten by dog, subsequent encounter
W540XXS Bitten by dog, sequela
W541XXA Struck by dog, initial encounter
W541XXD Struck by dog, subsequent encounter
W541XXS Struck by dog, sequela
W548XXA Other contact with dog, initial encounter
W548XXD Other contact with dog, subsequent encounter
W548XXS Other contact with dog, sequela
W5501XA Bitten by cat, initial encounter
W5501XD Bitten by cat, subsequent encounter
W5501XS Bitten by cat, sequela
W5503XA Scratched by cat, initial encounter
W5503XD Scratched by cat, subsequent encounter
W5503XS Scratched by cat, sequela
W5509XA Other contact with cat, initial encounter
W5509XD Other contact with cat, subsequent encounter
W5509XS Other contact with cat, sequela
My parents are MDs, and they hate this stuff. Mostly because the onus is on doctors to perfectly use the correct code or not get reimbursed. (Or more realistically, waste time arguing with insurance companies/Medicare to get reimbursed.)
Sadly, my first job out of college involved these codes after we wrote a rural health grant. The money and pain that went into that thing still wakes me up at night. The codes (and the cost of acquiring the "book" along with filling out the forms) gave me fits and actually made me think heavily about calling in sick for work each morning in the shower.
Interestingly, I heard about that a couple of months ago going to a med conference and listening to Atul Butte. Here is the longer narrative of the taxonomic structure of death causes:
(By the way, the rest of Atul's talk is also quite interesting, too, for people who are looking for building the next open-source bio/medical-informatics company in their garage.)
I can think of examples of all of these. But I did have siblings, burn myself bbq'ing, know people who worked in the local slaughterhouse (knife in the arm to get off work), know of a surgeon who made this terribly sad mistake, live in the UK (IRA letter bombs).
I knocked one of those quartz desklamps over on my bed when I was asleep. Set the blanket on fire, caused it to melt. Fortunately, I was awakened before I was injured. Not sure if that would count, though.
When I was younger, I had a commercial-grade stapler (the big ones that advertise stapling through N-hundred sheets at once) go into my pointer finger on my left hand. The resulting bone infection eroded all the bone in my fingertip, which was reconstructed later from "donor" bone.
Step one of the operation was getting taken back to a patient room, being given an IV (since I was not to eat or drink for 12hours before the operation), and waiting. After a few hours, a nurse walked in with a sharpie and wrote "NO" on my other hand.
A "rabbit hole" for you... A major annoyance for me (a paramedic). Accurately categorizing the stupidity humanity can be surprisingly time consuming...
Interesting this should pop up, a few weekends ago I put together a simple quick search for ICD-10 codes (and Radlex, a radiology specific lexicon) at http://lex.orionmd.com. I'm sure there are other more powerful tools out there, but feel free to play around!
Apropos. Thomas Morris' excellent blog about historical medical cases is super interesting, using reports from old medical journals as source. Eg "The woman who peed through her nose":
Some of the most mildly interesting:
V9543XD Spacecraft collision injuring occupant, subsequent encounter
W5602XD Struck by dolphin, subsequent encounter
X35XXXD Volcanic eruption, subsequent encounter
X52XXXD Prolonged stay in weightless environment, subsequent encounter
Y0881XD Assault by crashing of aircraft, subsequent encounter