It was a hot summer day when I stopped my old Cadillac convertible on the side of the road. I had planned to get out and search for cow skulls. (It was during my “painted bone” phase.) However, when I parked the car, I noticed a hideous odor. It was the smell of death, of rotted mammalian flesh cooking in the 100-degree sun.
I quickly located the source: a dead armadillo by the side of the road. Now an expired armadillo is nowhere as picturesque as a dead skunk in the middle of the road. (For more on that, check out the song “Dead Skunk in the Middle of the Road” by Loudon Wainwright III.) Still, it was pretty interesting, though odiferous, especially for a Dasypodidae-phile like me. But I probably shouldn't have put the carcass in a bag in the trunk. The car smelled for a week.
I planned to lay the carcass over a fire-ant bed to clean the skeleton. I hoped I would not get Hansen's disease, otherwise known as leprosy and transmitted by armadillo contact, but I was pretty sure I wouldn't. The bigger risk seemed to be to others—people who got sick from having to hear me repeatedly tell the story.
But what if I had gotten leprosy from the armadillo? Under ICD-10, I'd be out of luck.
Having a common language of disease is essential to medical progress. In the 1700s, naturalists like Carl Linnaeus hoped to classify species with a standardized naming system, known well to most Homo sapiens. His contemporary, François Boissier de Lacroix, attempted to do the same with diseases in his book “Nosologia Methodica.”
In 1837, William Farr was hired as the first medical statistician in the General Register Office of England. He felt the “advantages of a uniform statistical nomenclature...are so obvious.” He arranged diseases under 5 major groupings: epidemic, constitutional, localized, developmental, and traumatic.
In 1891, the International Statistical Congress met in Vienna. Jacques Bertillon, chief of statistics in Paris, led the meeting with his own classification of causes of death. These definitions were accepted worldwide. Ten years later, in August 1900, the first International Conference for Revision of the Bertillon Causes of Death created an updated classification system and recommended follow-up meetings every 10 years, although this recommendation was not followed.
ICD-10 is the latest and greatest iteration of Jacques Bertillon's system, with 140,000 codes. It requires exact localization and precise verbiage. By now all physicians are familiar with it. Long gone is regular old atrial fibrillation; now it must be paroxysmal, persistent, or permanent. Acute asthma has blossomed into 4 codes, with mild, moderate, severe, and intermittent or persistent.
The only fun things about ICD-10 are the strange codes, like V02.91XA (pedestrian on roller skates injured in a collision with a 3-wheeled motor vehicle) or V90.26XS (drowning and submersion from jumping from a burning kayak). It also includes 10 chicken codes, from W61.32XA (struck by a chicken, initial encounter) to the intriguing W61.39XS (other contact with chicken, sequela). These codes are real. Go online and check them out for yourself.
So what does this have to do with my encounter with an armadillo? Imagine, if you would, that I contract leprosy from this ill-considered taxidermic diversion and go to my doctor, who never fails to be amazed by the depth of my personal idiosyncrasies and general lack of common sense. He goes to bill for the visit, but alas, there is NO CODE for armadillo exposure! Nor is there one for skunk-related injury. There is a code for being bitten by a macaw, initial encounter (W61.11XA), but not for an armadillo. The little tank-like creatures may be swarming across the South, but unless a macaw nibbles on you at the same time, you're out of luck.
I say to my PCP that it will be all right—I had also been stomped on by a donkey and head-butted by a sheep. (Let's say that after I got home from the armadillo expedition, my son dragged me to a petting zoo put on by his school.) We go online, but amazingly, there are also no codes for sheep or donkey injuries. How can this be? Furthermore, there is a code for being bitten by a sea lion (W56.11XA), but not by a regular lion. Who wrote these codes?
So, in my hypothetical scenario, I just go home. My PCP says not to worry: If there is no code for it in ICD-10, there is no way I could have an armadillo-related disease. I'll have to wait for ICD-11. Maybe I can come back then.