weird (medical) coding
ICD-10 codes
I started this week planning to write about something completely different. Then I stumbled across a random old news story: SeaWorld got fined $16k after a trainer was injured by an orca in 2024. I, being a healthcare nerd, wondered whether that was covered by Seaworld’s health insurance. So I looked it up.
W56.22XA: "Struck by orca, initial encounter."
Wait, what? There's a medical code specifically for orca attacks? How many people are getting struck by orcas a year? Did a doctor have to scroll through a drop-down going "nope, not an alligator attack, not an eagle attack, not a bear attack... ORCA?" Did somebody in United Healthcare's claims department reject the claim and say you typo'd the billing code? We're not paying for this.
And most importantly, what are the other weird billing codes out there, and why do they exist?
And there went my friday afternoon.
icd-10 codes? huh?
Ok, if you're not a healthcare nerd, here's the TLDR.
ICD-10 codes exist so your doctors get paid. They’re a lookup table that translates every medical condition into billable categories for insurance companies. Each code gets paid a certain amount, and we've spent years and years fighting between doctors and insurance companies to make the system ever more complex, inscrutable, and most importantly, gameable.
Like there are literal associate degrees just to train people how to navigate it. Medical coding specialists earn salaries of $50-90k a year to master the art of matching diagnoses to the most advantageous billing codes.
Choose the wrong code and insurance denies payment; choose the right code and suddenly that routine office visit becomes significantly more profitable. This has created an entire cottage industry of "coding optimization," where healthcare providers use tech and train doctors to find creative but legally defensible ways to maximize reimbursements. Chronic headaches can be coded as "migraines" (worth more money) versus "tension headaches" (worth less). Surgeries last 46 minutes or 61 minutes, so anesthesiologists can bill for 4 or 5 fifteen-minute blocks. The doc always gets your temperature and gives your lungs a quick listen to turn a “consult” into a “physical checkup” (50% more profitable).
In 2015, the U.S. healthcare system upgraded from ICD-9 (about 13,000 codes) to ICD-10 (over 68,000 codes). Think about that for a second. We quintupled the number of ways to categorize medical misfortune.
The stated goal was more precise medical documentation for better healthcare outcomes. The actual goal? More billing granularity, in our eternal healthcare tug-of-war. And now, we have a system so specific that there's a separate code for being injured by a chicken during your first visit versus subsequent chicken-related medical encounters.
Yes, that's a real distinction. W61.33XA vs W61.33XD.
so, as promised, silly icd-10 codes
W59.22XA: "Struck by turtle, initial encounter" I spent way too long trying to imagine the physics of how a turtle "strikes" someone. Are we talking about a projectile turtle? A surprisingly aggressive snapping turtle? The code exists, so somewhere, someone needed medical attention after a turtle-related incident severe enough to require professional healthcare.
W61.62XA: "Struck by duck, initial encounter" The mental image of filling out insurance paperwork explaining that yes, you were indeed struck by a duck is delightful. Also, ducks are assholes.
There’s codes for where you got injured too. How’s these:
Y92.146: "Swimming-pool of prison as the place of occurrence of the external cause"
Y92.253: "Opera house as the place of occurrence of the external cause" covers injuries sustained during cultural enrichment activities.
Y92.024: "Driveway of mobile home as the place of occurrence of the external cause"
Y92.72: "Chicken coop as the place of occurrence of the external cause"
There’s far out ones:
V95.43XA: "Spacecraft collision injuring occupant, initial encounter" Honestly, if someone made it to a hospital after that, that’s a win.
X52: "Prolonged stay in weightless environment." This code documents space adaptation syndrome. Fun fact, NASA informally measures space sickness in "garns," named after Senator Jake Garn, who, well, as NASA physician Dr. Robert Stevenson put it:
Jake Garn, he has made a mark in the Astronaut Corps because he represents the maximum level of space sickness that anyone can ever attain, and so the mark of being totally sick and totally incompetent is one Garn. Most guys will get maybe to a tenth Garn, if that high.
And rather relatable ones:
W22.02XA: "Walked into lamppost, initial encounter" bwhahaha yup I’ve done this…
Z63.1: "Problems in relationship with in-laws" I wonder what this is billed at.
Z62.891: "Sibling rivalry" Can confirm this is probably the most common way kids get hurt. Once I, 8, took my glasses off. My 3-yr-old sister was amazed…so amazed that she poked me in the eye, to see if my glasses really left.
And, well, ones that aren’t quite as fun…
V91.07XA: "Burn due to water-skis on fire, initial encounter" sounds like a Florida man, but I found a real case. It was a Florida woman. Megan Hawthorne, an EMT from Florida, suffered burns over 20-25% of her body when her jet ski exploded in 2020.
V97.33XA: "Sucked into jet engine, initial encounter." Eek…
Anyway, I hope you don’t get diagnosed (and billed for) any of these codes! Until next week!