ICD-10...A ZERO SUM GAME?

"W21.04XA Struck by ball initial encounter."

We go to extremes to measure and quantify and then base assumptions on the likelihood of our premise, whether what we are seeing is reality or a smidgen of it. And if so, how can we predict further into the future about trends and human progress.

Well now, here comes the ICD-10 coding information for billing medical encounters:

Let us look at one specific code for an example: W21.04XA Struck by ball initial encounter.

If you are a golfer you will see what I mean. It is so obvious how pathetically limited the measure is in extracting information. For instance why not add a L and a R modifier to the code and make it: W21.04XAL and W21.04XAR for a hook related injury and a slice related injury from a golfer’s club. That way the Insurer and Government can know the predilection of the golfer and his capabilities and send a mandate for all L and R golfers to have their drivers levo or cis rotated for optimization. Another characterization would be to use S modifier for a “skulled” hit. So now we might have W21.04XALS or a W21.04XARS. Given the dimensions of the game an important measure would be the location of the injured individual if he or she is standing less or more than 90 degrees to the golfer with modifier Y for  less than 90 and Z for  more than 90. In that case we might have another modifier: W21.04XA L/RY and W21.04XA L/RZ. But that is not enough either. What about the club and the ball. If it is a Ping or Nike the modfiers could be P or N and if the ball is Titleist or Noodle additional modifiers would help because the balls have different cores the latter is much softer. So a modifier T and N would make it W21.04XA L/RT or W21.04XA  L/RN. We cannot forget the course however as it relates directly to the ability of the injured party and golfer to play in a public course (cheaper) or a private course (expensive). One could use lower case modifiers as pu and pr making our code: W21.04XA L/R/Y/Z/T/N pu and W21.04XA L/R/Y/Z/T/N pr.  One more thing we need to know what time the injury took place for example; morning , noon or evening. The relevance is obvious! The modifiers would be MO, NO and EV at the end: W21.04XA L/R/Y/Z/T/N pu/pr MO, W21.04XA L/R/T/N pu/pr NO, W21.04XA L/R/Y/Z/T/N pu/pr EV. We did forget the fact whether the golfer swinging the club is a left-handed or right-handed and an appropriate modifier would be le and ri: W21.04XA L/R/Y/Z/T/N pu/pr MO/NO/EV le and W21.04XA L/R/Y/Z/T/N pu/pr MO/NO/EV ri.

Here is the code for a patient submitted for payment. W21.04XA R/S/Y/T/pr/EV/ri one would immediately know that it was a right-handed golfer with the injured party standing less than 90 degrees to the golfer on the right side go hit by a slice with a Titleist ball on a private course in the evening.

Armed with this information the Insurer can deny payments for the injured person standing less than 90 degrees to the right handed golfer with a slice, while the lawyer can use it to sue the golfer for allowing the injured party to stand less than 90 degrees to the golfer.

Let loose a couple of bureaucrats and the dogs of war!

A zero sum game - of intellect!