When Squirrels Attack! Disaster Averted with ICD-10

May 8th, 2014 / By Rhonda Butler

This latest ICD-10 implementation delay stinks even more than the first one, when HHS succumbed to pressure and moved the implementation date from 2013 to 2014. I could pretend to be a wine connoisseur, and describe the taste of this delay in great detail—the acidic AMA “mouth feel,” the conspiracy theory “notes,” the voice vote “finish.” But why bother? And there, my friends is the dilemma we all face—why bother indeed? If a massive effort to do something sensible and constructive in health care can have the rug pulled out from under it at the last minute, why do we bother? As a friend said after the “doc fix” bill became law and ICD-10 was put in limbo for (at least) another year, “It makes me feel like moving to Montana to live in a cave.”

Nevertheless, we are going to continue to push for ICD-10 implementation as soon as possible, because it is what we can do. The industry is so thoroughly committed to ICD-10 it cannot turn back now. At the same time, how do we as rational human creatures try to make sense of a situation that has become patently absurd? My advice is, don’t even try. Just let yourself enjoy the absurdity, because it is likely to be with us for some time. As my contribution to “Operation Enjoy the Absurdity” I propose a little Chicken Broth for the ICD-10 Soul to help tide us over while we wait, and wait some more.

However, this is soup with a twist. My “heart-warming” anecdotes are all made up—a benign fiction, unlike the malicious fictions published by opponents to ICD-10 over the past several years. I hope these fractured ICD-10 fairy tales make you smile—even a groan will do. If you feel similarly inspired, send your own ICD-10 chicken broth tales, poems, whatever you can dream up, to me at rrbutler@mmm.com so we can post them here. Let’s get some outrageous ICD-10 urban legends of our own out in virtual space and see what happens to them. Hopefully we can all get back to work on ICD-10 after a few good laughs.

Here we go—

When Squirrels Attack! Disaster Averted with ICD-10

Rupert Maelstrom, a cook at the Tidye Heather village primary school in Shropshire, England, enjoyed feeding the squirrels in his neighborhood each morning as he walked to work. Rarely did he forget to fill his pockets with sunflower seeds for his furry friends. A few of them had become so accustomed to him that they would take sunflower seeds right out of his hand. His favorite was a squirrel with a distinctive kink in his tale. Rupert named him Chester.

One morning, Chester came running over to Rupert with his usual enthusiasm, but instead of taking the proffered sunflower seed, he bit Rupert’s index finger. Rupert was surprised of course, but he thought perhaps Chester’s aggressive behavior was just a touch of spring fever—Rupert had a bit of that himself. Since it was only a small puncture wound that didn’t bleed at all, Rupert promptly forgot about the incident.

Three days later, Rupert woke up feeling like he might be coming down with something. He took a couple of ibuprofen, had an extra long shower, and went to work. While Rupert was whisking pudding for the children’s lunch, he became too weak to stand, and was found by a coworker minutes later lying on the floor drooling and mumbling incoherently. Rushed to the hospital, Rupert was diagnosed with rabies. Sadly, it was too late for him to be saved by post-exposure treatment—he had waited too long. Rupert became remarkably lucid in his last moments, and spent his remaining energy relating the story of the day he was bitten by Chester the squirrel. It was clear that on his deathbed he understood that Chester had rabies, that the tiny nip to Rupert’s finger had killed him, and he did not want anyone else to suffer the same tragic fate.

As Rupert’s lifeless body was wheeled to the morgue, Mrs. Crumpet in the medical records office down the hall dutifully recorded the cause of death using the code set adopted in 1993 by England for the public good: ICD-10.

A82.1 Urban rabies

W53.21XA Bitten by squirrel, initial encounter

This information was shared instantaneously across England’s nationwide electronic public health surveillance network, which alerted all health providers, schools, and other public buildings within a ten-mile radius of Rupert’s home that a case of squirrel bite rabies had been reported in the area. This timely, effective use of health information arrived just in the nick of time, for it was clear that Tidye Heather was on the verge of a rabies epidemic. In the three days since Rupert’s exposure, a total of five children had reported being bitten. Although each of the five children was treated in time, all were too agitated to clearly describe their attacker.

Thanks to the squirrel bite code on the Rupert’s medical record, epidemiologists were able to learn that a squirrel was the source of the rabies epidemic, trap all the squirrels in the area, and halt what could have been a national tragedy.

To commemorate Rupert’s passing and the role of ICD-10 in averting disaster in Tidye Heather, the village council erected a small wooden marker in the village green that said simply,

“Thank heaven for Rupert Maelstrom (1981-2013)

Thank heaven for ICD-10”

Rhonda Butler is a Senior Clinical Research Analyst with 3M Health Information Systems.