Dumb Ways to Die: The 8 Not Dumbest ICD-10 Codes

Yes, there are ICD-10 codes for exceedingly rare ways to die, and yes, they are easy to parody. This does not matter at all, since not many people are admitted to the hospital for a prolonged stay in a weightless environment. What does matter is that preventable errors in hospital care are the third leading cause of death, after cancer and heart disease. Updated estimates in a 2013 study in the Journal of Patient Safety say that between 210,000 and 440,000 people die in US hospitals every year because some preventable harm was done to them. The Office of the Inspector General published its own 2010 estimate only for Medicare patients, determining that poor hospital care was a contributing factor in the deaths of 180,000 of them. Even the universally accepted and much older number (published in 1999) of 98,000 is widely considered a “crisis” and a “national priority” in health care. And remember, these numbers don’t even attempt to quantify the financial and human toll of poor quality care that doesn’t kill people, but just costs us money and time and causes needless suffering. Why can’t we accurately track something this important? Because ICD-9 lacks the detail to allow complications and errors in medical care to be easily entered in the permanent medical record so these events can be accurately measured. And as the saying goes, if you can’t measure something, you can’t understand it, and if you can’t understand it you can’t control it. ICD-9 codes are pitifully inadequate for measuring the occurrence of preventable medical error. Instead of talking about the dumbest ICD-10 codes, we should be demanding the ICD-10 codes we need to start measuring and understanding and controlling these totally unnecessary healthcare costs. Here are just a few examples that show the difference between what you can say about complications, adverse effects, and errors using ICD-9 and what you can say using ICD-10. ICD-10 says T36.0X5A Adverse effect of penicillins ICD-9 says 995.29 Unspecified adverse effect of other drug, medicinal and  biological substance ICD-10 says T88.4 Failed or difficult intubation ICD-9 says 999.9 Other and unspecified complications of medical care, not elsewhere classified ICD-10 says T88.51XA Hypothermia following anesthesia, initial encounter ICD-9 says 995.89 Other specified adverse effects, not elsewhere classified ICD-10 says T86.822 Skin graft (allograft) (autograft) infection ICD-9 says 996.79 Other complications due to other internal prosthetic device, implant, and graft ICD-10 says R57.1 Hypovolemic shock [shock from severe dehydration] ICD-9 says 785.59 Other shock without mention of trauma ICD-10 says Z20.6 Contact with and (suspected) exposure to human immunodeficiency virus [HIV] ICD-9 says V01.79 Contact with or exposure to other viral diseases ICD-10 says I97.711 Intraoperative cardiac arrest during other [non-cardiac] surgery ICD-9 says 997.1 Cardiac complications, not elsewhere classified ICD-10 says J95.71 Accidental puncture and laceration of a respiratory system organ or structure during a respiratory system procedure ICD-9 says 998.2 Accidental puncture or laceration during a procedure, not elsewhere classified What matters about codes is not how many there are, but how precise they are. If heaven forbid you or someone you care about suffers the consequences of a preventable medical mistake, look at the way it will be entered on the permanent medical record in ICD-10, and then look at how that exact same condition will be recorded in ICD-9. Lobbyists are fighting tooth and nail to keep using the ICD-9 system. Letting a few animal bite codes stop us from using the power of ICD-10 to measure and understand and begin to control preventable medical errors—really, how dumb is that? Rhonda Butler is a senior clinical research analyst with 3M Health Information Systems.