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Attacked by an orca? There’s now a medical code for that.

On Thursday, the United States’ sprawling health-care bureaucracy makes a massive transition.

Few doctors will ever see a patient who has been struck by a orca whale.

But now, if they do, they’ll at least know how to properly bill the insurance company for treatment.

On Thursday, the United States’ sprawling health-care bureaucracy makes a massive transition. For decades, medical providers have relied on ICD-9, a set of 14,000 medical codes to denote the various ailments and injuries they treat. But beginning October 1, and after multiple delays and more than a decade of preparation, the United States switches to a much more granular set with 68,000 codes — including, yes, a billing code for patient struck by orca.

The new set of codes is called the 10th Edition of the International Classification of Diseases, or ICD-10 in health care parlance. ICD-10 has codes for lots of normal ailments, like pneumonia (J18.9) or a broken arm (S52.501A). But it also has codes for things like getting struck by an orca (W56.22xA), being sucked into a jet engine (V97.33xD), or for getting hit by a motor vehicle while riding an animal (V80.919)

This can all sound a little absurd, especially when you learn that it’s costing the United States more than $1 billion to transition to the new code set, as medical software gets upgraded and medical coders get retrained.

But we’re actually one of the last developed countries to switch to ICD-10; others have used it for years. They do so because while granularity can be maddening, it can also be really useful. Consider someone who researches how human and orca environments interact and who wants to know, for example, if we’re increasingly encroaching on the whales’ habitat. For that researcher, data on orca encounters could actually be really important — and now, because of ICD-10, they’ll have it.

It’s possible that ICD-10 will make it easier to root out health-care fraud, too. One thing it adds to each medical billing code is the denotation of whether something happened on the left or right side of the body. In the past, if a doctor billed for two knee replacements, insurers could assume that they worked on both knees and let it slide. But billing for two left knees on the same patient would raise a red flag.

Still, this doesn’t mean health-care experts can’t poke a bit of fun at the new codes. A few years ago I covered a medical billing conference that sold shot glasses printed with the code F10.950 — the code for an unspecified alcohol-induced psychotic disorder.

A group called ICD-10 Illustrated has taken to illustrating some of the most unlikely injuries, conjuring up what it would actually look like for a toe to inexplicably go missing (code Z89.419) or when people get sucked into jet engines for a second time (V97.33xD). They kindly agreed to let Vox run a sampling of their artwork, and you can see even more on their website,, where a book of these images is available for purchase.

Z89.419: Acquired absence of unspecified greater toe


W21.100xA: Struck by hit or thrown ball, unspecified type, initial encounter


W56.22xA: Struck by an orca, initial encounter


V81.5xxA: Occupant of a railway train or railway vehicle injured by fall in railway train or railway vehicle, initial encounter


V97.33xD: Sucked into a jet engine, subsequent encounter


V00.01xD: Pedestrian on foot injured in collision with roller skater, subsequent encounter



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