Edwin Leap, MD


This piece was originally printed in Emergency Medicine News

The 20 codes for EMS; describing the indescribable

How many times have you heard this on the radio:  “Yeah, base, this is Medic 3, and we’re 15 minutes from your facility with a 38 year old white male with, uh, with, some chest pain, numbness all over, headache and anxiety, as well as some bruises from a fall.  He says his pain radiates from his earlobes to his nipples and well, we’ll just give you more details on arrival, base.  This is Medic 3 clear.”

God love those guys and gals, the truth is, if we doctors were on the truck ourselves, we still wouldn’t know what the diagnosis was.  Frequently, when I discharge people from the emergency department, I still don’t know what the diagnosis is.  Thank heavens for ‘Medical Screening Exam’, because that’s about the best I can do some nights.

But I have come to realize that if the medics can’t figure out what to call it in the field, I may be just as puzzled.  Now, physicians live with a much greater sense of ambiguity than paramedics do.  Paramedics have to work within the confines of more straightforward algorithms, designed to save life in a pinch.  But people are puzzling, and sometimes their emergencies and actions defeat the most obvious treatment plans and education, and leave even the brightest going, ‘I just don’t get it…’.

So, in order to help our EMS colleagues, and facilitate our preparation on the hospital end of things, I’ve compiled a list of signals based on common complaints transported by ambulance, and loosely based on our old friends, the 10 codes.  These are much more specific, and much more likely to be used on a daily basis. (Personally, I think they might be useful CPT codes, as well).  I mean, what’s a medic to say when the patient’s complaint is ‘bitten by ex-wife’s pet squirrel’?  Or ‘Penis stuck in mixer bowl’?

I’ve attempted to answer those questions with the following system of 20 codes.

Feel free to post near your EMS desk!  They just might catch on…

20-100    Chest pain from stupid argument

20-101    Chest pain from anxiety

20-102    Chest pain from trampoline injury

20-103    Chest pain from being punched by wife

20-104    Chest pain from boring/dead-end job

20-105    Chest pain, non-urgent, not otherwise specified

20-200   Laceration from altercation with small child

20-201   Laceration from argument with dog

20-202   Laceration from reaching through broken window for beer

20-203   Laceration from opening beer with mouth

20-204   Laceration from inappropriate use of household implement while naked

20-205   Laceration from stupid activity, not otherwise specified

20-300   Overdose on normal dose of Xanax

20-301   Overdose on normal dose of Ambien (also known as sleep)

20-302   Overdose on ridiculous amount of alcohol, attributed to ‘some pill in drink’

20-303      Overdose on confidence, resulting in sound beating or ugly bed-mate

20-304      Overdose on nicotine after recent coronary stint (also known as Acute MI)

20-305      Overdose on non-lethal substance, not otherwise specified (like flour)

20-400   Back pain from lifting refrigerator alone

20-401   Back pain from lifting uncooperative farm animal

20-402      Back pain from having bizarre sex with obese spouse

20-403      Back pain from assuming normal, standing posture while morbidly obese

20-404   Back pain from threat of imminent employment or loss of benefits

20-405   Back pain, unverifiable, not otherwise specified

20-500    Intoxication with fall onto face

20-501    Intoxication with fall out of bed

20-502    Intoxication with fall from bar-stool

20-503    Intoxication in the face of angry spouse

20-504    Intoxication on mouthwash (‘so she won’t know I’m drunk’)

20-505    Intoxication with ridiculous injury, not otherwise specified

20-600    Multiple wounds from jello-wrestling with raccoons

20-601    Lacerations from letting Pit-Bull eat off of body  (see 20-505)

20-602    Antler wounds from attempting to field dress game animal ‘mostly dead’

20-603    Bites from attempting to dress ferret as ‘Ballerina Barbie’

20-604    Lacerations to eyelids from attempting to bathe cocaine-intoxicated cat

20-605    Animal related wounds, not otherwise specified

20-700    Multiple stings from attempting to add hornet’s nest to collection.  In June.

20-701    Burns from attempting to kill yellow-jackets with gasoline, while smoking

20-702    Envenomation from attempting to cuddle with Pit Viper.

20-703    Small red mark, believed to be ‘spider bite’

20-704    Bite or envenomation with offending creature in possession (no, no, no!)

20-705    Bite or envenomation, non-urgent, not otherwise specified

20-800     Patient wearing demeaning, but hilarious attire  (e.g. ‘Bootylicious’ on shorts)

20-801     Patient in need of immediate arrest

20-802     Patient with wife in ambulance, girlfriend coming by private auto (surprise!)

20-803     Extraordinarily attractive patient  (probably needs decon)

20-804     Patient with non-urgent but completely unintelligible complaint

20-805          Patient, annoying, not otherwise specified

20-900          Shortness of breath from walking to refrigerator

20-901          Shortness of breath from thrilling episode of reality show

20-902          Shortness of breath from argument with prom date

20-903          Shortness of breath from smoking 4 ppd in small room full of cat fur

20-904          Shortness of breath from wrestling with law enforcement

20-905          Shortness of breath, no objective signs, not otherwise specified

As you can see, this system is still in its infancy.  However, if you would like to submit codes of your own, please do so through my website.  We could revolutionize both EMS and billing!  And we could learn to speak in cryptic but hilarious code behind the backs of our more illustrious ‘clients’.

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