Subsequent Encounter

Crime Rx

In 1991, a crew member aboard the USS Theodore Roosevelt was sucked into a running Pratt & Whitney J52 jet engine.

He survived. Blown eardrum, broken collarbone, some minor cuts—and then he walked back into the rest of his life.

I know this not from his medical record—HIPAA protects that—but because the incident itself lives in public military and aviation records. And I know something else about the incident that happened on what was probably the worst day in this guy’s life: the incident has a code. Specifically V97.33XA: sucked into jet engine, initial encounter. Wait, really? Is that a thing that could happen more than once? Asking for a friend.

Well. Probably not exactly. But what really happens is carefully documented by people who keep score. Jet Engine 1, Human 0.

Because behind every one of these codes sits a medical billing coder—a creature you have almost certainly never seen and never will. These unicorns of hospital administration work in the background, translating a doctor’s notes into ICD-10 codes (what went wrong) and CPT codes (what was done about it), because in the US model, insurance only pays when the diagnosis justifies the treatment. It’s an arcane ritual. And the keepers of the code—in the US, the ICD-10 Coordination and Maintenance Committee, comprised of the NCHS and CMS agencies—have a code (or two) for nearly every terrible thing that can happen to a human body. Even if it happens more than once.

So, V97.33XD, sucked into a jet engine, subsequent encounter, doesn’t mean the hapless crew member got sucked into a jet engine a second time—rather, it tracks his ongoing recovery. Remember that as unlikely as it sounds, he survived. So think an established patient, office or outpatient visit (CPT 99213) or CPT 92504, diagnostic binocular microscopy to see about that eardrum.

But wait, there’s more. V97.33XS. ‘S’ for sequela. Because getting sucked into a jet engine isn’t something a person just shakes off. That blown eardrum might cause problems down the road—like a V97.33XS with a CPT 92557 chaser (a comprehensive audiologic evaluation) to check out that hearing.

And it gets weirder. So you know I am here for that. How weird? Vote your favorite in the poll (below) and I’ll do my best to bring it.

1. Struck By. Struck by an animal. Struck by a human. Struck by a plant. Struck by stuff falling out of the sky. Struck by stuff exploding out of the ground. You know the drill.

2. Personal Ick. Bizarre personal appearance. Problem in relationship with in-laws. Flatulence and related conditions.

3. Don’t Go There. Bad things happening at the library, or the opera house or other cultural, entertainment and public venues. Also at a prison swimming pool.

If you think it can’t happen here, it already has—and ICD-10 has got you covered should you have an encounter (subsequent or otherwise).

You’re welcome.