I used to think that lawyers were the vilest creatures alive but I was wrong. There's a population out there that's lower, meaner and more dasteredly; health insurance coders. Here's how they work. You go into the doctor because you cut your finger off. The doctor sews it back on and everything is fine except that your finger is a quarter of an inch shorter now.
In the next couple of days your doctor's office files a "claim" with your insurance company so they can get paid. It says who you are, and uses a numeric code (CPT code) to say what was done. However, since the insurance company pays for different things at different rates, the doctor's office "upcodes" (that's a real word) the claim. They bill the suturing, the nerve repair and the blood vessel rehookup (not a real word) separately.
Off this goes to the health insurance guys for "downcoding." "Nope, nope" they say. "That wasn't surgical reconstruction on that bone. It was just set."
On and on this goes while you get a zillion pieces of mail that say things like "explanation of benefits," "This is not a bill," and "We want you to feel stupid." It all ends when they agree that you had brain cancer and send you a bill for that.
What does this have to do with Gore Mongering? It's the code man. It's the code. Every gory thing you can imagine a doctor doing to a patient is cleverly hidden away in the five digit CPT code. Let's take a look
11000 – Scraping (debriedment) of up to 10% of the total body surface.
10040 – This is a generic code for acne surgery. I'm not sure what they do but, if you need it, you'll know.
11750 - The permanent removal of a fingernail.
11950 – Here's an important one. It's the injection of substances (like collagen) under the skin. It's how movie stars get those lips.
22841 – In this little adventure the patients are laid on their stomachs, their backs are cut open and they get their spines wired together.
27590 – One of many wonderful amputation codes. This one from the thigh down.
30110 – This one hurts just to think about. In this code, the nose is held open, a scalpel is inserted and a small wedge of the lining of the nose is cut out to be biopsied.
31588 – This is a "not otherwise specified" code for repair of the larynx. The coder's handbook suggests that it should be used for burns. Burned larynx? That's my kind of a cookout.
41252 – Took a knife to the tongue? The good doc will sew it shut for you using this code.
41140 – Or we could just remove the tongue.
42860 – This is the burning off of polyps on the tonsils with an electrocauterizer. Burning...mmm gotta love that smell.
44132 – This is the transplantation of a section of bowel from a cadaver to a living host. I hope they wash it before they put it in.
45308 – This code troubles me. It is an endoscopy with tumor removal by "hot biopsy forceps..." Ouch. I don't need hot forceps in my endo if you know what I mean.
46947 – This is the repair of hemorrhoids by stapling. Why you'd go to the doctor for this, I don't know. It's the kind of thing we do in my office to keep ourselves awake during meetings.
53850 – This is the destruction of the prostate by "microwave thermotherapy." Wow. How do you suppose they get the microwave up there?
65091 – This is the removal of the iris, lens, retina etc of the eyeball. Only the shell is left.
65430 – Scraping of the cornea.
67875 – The sewing of someone's eyelids shut. This is sometimes called a "Frost Suture."
67971 – This is the repair of one eyelid using skin from the other.
85002 – This deceptively simple code is a test where they stick you and see how long it takes for you to stop bleeding. I think it makes a great party game as well.
89329 – Ok. This test bills itself as, "Sperm evaluation; hamster penetration test." I'm not kidding. I think that's illegal in this state.
91123 – This is the washing out of an impacted bowel with a pressure washer.
It's also interesting to note that the CPT coders divide the body up by the "Rule of Nines" when it comes to burns. If you burn your head in a fire, you are said to have burned 9% of your body. The same if you have burned one of your arms. The front or back of your torso on the other hand, along with either leg counts as 18% of your body. That's where the news gets those handy numbers on burn victims.
There is an additional 1% of the body after all the 9s have been added up. I'll let you figure out where that is. Now get out there and write.
If you've enjoyed this article, please consider supporting me on Patreon.
YOU ARE READING
The Gory Details (Gross)
HorrorBetween 2004 and 2008 I wrote a series of "Tips for Writers" for Nocturnal Ooze magazine vaguely about what would happen in real life if you did the things they do in movies but mostly about the gross out. I've always loved them and so have taken...
