The U.S. International Classification of Diseases has 72,616 problems; “Legal intervention involving injury by explosive shell” is one

There is seemingly an endless array of things that can cause us harm, from burns to bicycle accidents; from food poisonings to insect bites. And the United States Center for Medicare & Medicaid Services (CMS)—the effective industry leader in American health insurance—has seemingly attempted to code all the things that can possibly go wrong, and they have attempted to do this in the most efficient and appropriately granular manner possible. The results are the “International Classification of Diseases, Tenth Revision, Clinical Modification“, or the ICD-10-CM, medical diagnostic codes; the U.S.-localized version of the World Health Organization’s ICD-10 standard.

The breadth of diagnostic detail is sometimes eye-opening:

Rakes, be warned

The ICD-10-CM diagnostic codes are intended to allow any given medical diagnosis to be coded in elaborate detail, capturing the full conditions surrounding an aliment including the location it occurred (e.g. prison, middle school, opera house, etc.). After surveying the entire list of diagnostic codes, I can say that the ICD-10-CM standard reads like a nightmarish guidebook of all the conceivable ways things can go wrong, from falling down a well (code W170), to getting lead-induced chronic gout (codes M1A10 to M1A29), to much worse.

There is cancer, organ failure, every kind of injury you can imagine, and a massive number of adverse drug reactions on the list. There is an entire category for what is euphemistically termed “surgical misadventure.” The level of detail is enough to induce nausea (code R110).

While most of the conditions and afflictions here are not appropriate for polite adult conversations—someone might accuse you of being antisocial (code Z72811) if you were to do so—I was able to find a handful of them that have entertainment value in the vein of “America’s Funniest Home Videos”; usually involving injury by animals, such as code W5321: “Bitten by squirrel”. (There is also code V9107, “Burn due to water-skis on fire”, which may have been included as a joke.)

While this survey is mostly just fun—intended to prevent the diagnosis of code Z732: “Lack of relaxation and leisure”—I end on a more serious note and include a complete listing of injuries deemed possible as part of a “legal intervention.” I also share an observation on the only diagnostic code in the ICD-10-CM that directly relates to harm caused by discrimination.

On Methodology

The vast majority of the 2021 codes I surveyed are already in effect, and the remaining will be in effect come October. While I don’t have access to data on the frequency or use of individual diagnostic codes in the U.S., I make the assumption that the specificity of a diagnostic code (e.g. “dog” instead of “mammal”) is generally reflective of the perceived commonality of that affliction in the United States.

For example, if “koala bite” were to appear as an ICD-10-CE diagnostic code I’m going to assume that kola bites are prominent enough in the United States to warrant their own category of harm, instead of being lumped into the generic category of code W5581: “bitten by other mammal”. (I use this assumption to claim that certain conditions are considered “common” even though I can’t say that with confidence.)

Also, in case you are looking for it, a plain-text version of the codes can be found here.

Here we go.

Part 1 – Killer Animals

Common Animals that can harm you in the ICD-10-CM

Mouse; Rat; Squirrel; Dog; Cat; Horse; Cow; Pig; Raccoon; Dolphin; Sea lion; Orca; Shark; Alligator; Crocodile; Turtle; Parrot; Macaw; Chicken; Turkey; Goose; Duck; Tarantula; Black widow spider; Brown recluse spider; Stingray; Wasp; Bee; Hornet; Caterpillar; Scorpion; Gila monster; Taipan; Coral snake; Rattlesnake; Scombroid fish; Ciguatera fish; Portugese Man-o-war; Sea anemone

The most common bad things some of these animals can do to you:

  • Peck you.
  • Bite you.
  • Strike you.
  • Scratch you.
  • Crush you.
  • Poison you.

Bad things Dolphins can do to you:

  • Bite you (W5601)
  • Strike you (W5602)
  • Other (W5609)

Part 2 – Death By Electric Scooter

Bad things that can happen to you on an electric scooter:

  • You hit a pedestrian with your electric scooter (V00031)
  • You fall off your electric scooter (V00841)
  • You collide with a stationary object (V00842)
  • You collide with a pedal cycle (V01131)
  • You collide with a two or three-wheeled motor vehicle (V02031)
  • You collide with a car, pick-up truck, or van (V03131)
  • You collide with a heavy transport vehicle or bus (V04031)
  • You collide with a railway train or railway vehicle (V05031)
  • You collide with some other non-motor vehicle (V06031)

Part 3 – Oh, the Places You Will Go…

All the places, according to the ICD-10-CM, where bad things can happen:

Airplane; Airport; Ambulatory surgery center; Amusement park; Art Gallery; Bank; Barn; Barracks on military base; Baseball field; Basketball court; Bathroom; Beach; Bedroom; Bike path; Boat; Building [any] under construction; Bus; Bus station; Cafeteria; Campsite; Car; Cell (prison); Chicken coop; City hall; College; Corridor; Courthouse; Courtyard; Daycare center; Desert; Dining room; Dock or shipyard; Driveway; Elementary school; Exit ramp or entrance ramp of street or highway; Factory; Farm field; Football field; Forest; Garage; Garage on military base; Garden or yard; Garden or yard on military base; Gas station; Health care provider office; High school; Highway rest stop; Ice skating rink (indoor) (outdoor); Interstate highway; Kitchen; Kitchen on military base; Library; Local residential or business street; Mess hall on military base; Middle school; Military training ground; Mine or pit; Movie house or cinema; Museum; Music hall; Oil rig; Opera house; Operating room; Orchard; Other ambulatory health services establishments; Other athletic court; Other athletic field; Other cultural public building; Other farm location; Other paved roadways; Other place; Other place on military base; Other public administrative building; Other recreation area; Other school; Other specified industrial and construction area; Other specified places; Other specified public building; Other specified sports and athletic area; Other trade areas; Other transport vehicle; Other wilderness area; Parking lot; Parkway; Patient bathroom; Patient room; Pool; Post office; Private driveway; Private garage; Public park; Railroad track; Railway station; Religious institution; Restaurant or cafe; Roller skating rink; Shop (commercial); Sidewalk; Slaughter house; Soccer field; Squash court; State road; Subway car; Supermarket, store or market; Swimming pool (public); Swimming-pool; Swimming-pool on military base; Tennis court; Theater (live); Trade school; Train; Truck; Unspecified place; Unspecified place military base; Unspecified place or not applicable; Unspecified residential institution; Unspecified school; Unspecified street and highway; Urgent care center; Zoological garden (Zoo)

Common buildings you can be hurt in:

Apartment; Boarding-house; Children’s home and orphanage; Hospital; Mobile home; Nursing home; Other non-institutional residence; Other specified residential institution; Prison; Reform school; School dormitory; Single-family (private) house; Single-family (private) house or garden; Unspecified non-institutional (private) residence

Part 4 – Legal Interventions

Things or actions that can cause you harm as part of a “legal intervention”:

  • a baton
  • a bayonet
  • a conducted energy device
  • dynamite
  • an explosive shell
  • a handgun
  • a machine gun
  • manhandling
  • a rifle pellet
  • a rubber bullet
  • tear gas
  • other blunt objects
  • other explosives
  • other firearm discharge
  • other gas
  • other sharp objects
  • unspecified blunt objects
  • unspecified explosives
  • unspecified firearm discharge
  • unspecified gas
  • unspecified sharp objects

Note: This entire category appears to exists, in-part, so that harm that might ordinarily be categorized as “assault” in other parts of the ICD-10-CM do not have to be coded as such when the action is done by a law enforcement official. For example, what might be “Y00 Assault by blunt object” if I were to hit you with a baton can become “Y35313 Legal intervention involving baton, suspect injured” when done by a law enforcement official.

Not making this up.

On Perception

One final note related to current events, I found that while there are 273 codes for injury due to “legal interventions” there is only a single diagnostic code in the ICD-10-CM that relates to the harm caused by discrimination or persecution:

Z605 – Target of (perceived) adverse discrimination and persecution

It’s worth emphasizing that there is literally no other category in the ICD-10-CM but Z605 that has “perceived” in the code description. While no one should doubt that racial and ethnic discrimination can be a factor in real psychological and physical harm, it’s telling that the current CMS diagnostic codes only allow it to be coded in a way that implicitly questions its very existence.

While the diagnostic codes for social exclusion and rejection (Z604), inadequate housing (Z591), lack of adequate food and safe drinking water (Z594), sexual harassment on the job (Z5681), an uncongenial work environment (Z565), and even sibling rivalry (Z62891) are all treated as inherently real by the diagnostic codes should we ask why harm caused by racism—among all the codes in ICD-10-CM—is the only one that is “perceived”?