The Codes that Disappeared

I take pride in my dermatological diagnostic prowess. The medical establishment seems not to.

Recently I saw three patients in just a few days with concerns about similar skin lesions that were all dermatofibromas. I couldn’t help notice that my EMR Diagnosis search came up blank. I had to pull out my iPhone and google the code. This happens often enough that I don’t have time to think much about it, but making the same search almost three days in a row, I registered some frustration.

Dermatofibromas are now bundled together with several other dermatological diagnoses that used to be pearls of pride in primary care, such as halo nevus, dysplastic nevus, histiocytoma and neurofibroma.

I grumbled internally because I knew that there was an ICD 10 code for much more specific and esoteric diagnoses, like drowning while diving for pearls.

Here are some examples of these phenomena:



I understand why: Medical coding doesn’t serve primary care clinicians anymore. Instead, it is the foundation for research into the epidemiology of infectious diseases, cancers and accidents. There’s simply no money and little interest in diagnostic accuracy for non lethal and non litigable medical conditions.

1 Response to “The Codes that Disappeared”

  1. 1 Henry Hochberg, M.D. November 17, 2017 at 1:59 am

    sucked into a jet engine: V97.33X
    water skis on fire: V91.07XA

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Osler said “Listen to your patient, he is telling you the diagnosis”. Duvefelt says “Listen to your patient, he is telling you what kind of doctor he needs you to be”.


CONDITIONS, Chapter 1: An Old, New Diagnosis

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