Doing a coding refresher while my kids were watching a movie, resulted in an epic crossover: Home Alone ICD10

First the title. 3 options:
Z62.29 Other upbringing away from parents
Z60.2 Problems related to living alone
T76.02XA Child neglect or abandonment, initial encounter
1/
The movies opens with household chaos. The protagonist (Kevin) is bullied by his older Brother “Buzz”.

Don’t worry there’s not one but two ICD10 codes for this:
1️⃣Y07.41 Sibling, perpetrator of maltreatment
2️⃣F93.9 Childhood emotional disorder, unspecified
2/
Kevin fears that Fuller (played by his real life brother Kieran) will wet the bed.

You can code this concern from Fuller’s perspective or from Kevin’s:
1️⃣N39.44 Nocturnal enuresis
2️⃣W55. contact with urine of unspecified mammal

3/
Buzz further torments his little brother by eating all his plain cheese pizza. This backfires on Buzz leading to:
🍕R63.2 Excessive eating
🤮R11.10 Vomiting, unspecified

4/
Kevin retaliates against buzz leading to
🥊 Z62.891 Sibling rivalry

(Eagle eyed fans will note that Kevins passport/ticket get accidentally thrown out with the milk stained napkins; this kinda explains how his terrible parents forget him)

5/
In the resulting fracas, Fuller gets smooshed by a chair causing:
👃S09.92 Unspecified injury of nose
(don’t worry he turns out OK, just watch Succession)

6/
The next morning:
F51.12 Insufficient sleep syndrome
Z63.79 Other stressful life events affecting family and household
7/
After rushing to the airport and boarding a flight to Paris, the family realizes they made a terrible mistake:

Z62.0 Inadequate parental supervision and control
F48.8 Psychogenic Syncope
8/
Z63.1: Problems in relationship with in-laws
Meanwhile
Z63.6 absence of family member due to disappearance
Skipping ahead to act 5, Kevin has to defend his house from the Wet Bandits. This entails:
🏠 F02ZBFZ Environmental, Home and Work Barriers Assessment
👨‍🔧Y93.D: Activities involved arts and handcrafts
🔨Z99.89: Dependence on enabling machines and devices, not elsewhere classified.
X95.01XA Assault by airgun discharge, initial encounter
S39.94XA Unspecified injury of external genitals, initial encounter
X95.01XD Assault by airgun 
discharge, subsequent encounter
W00.1 Fall from stairs and steps due to ice and snow 
W00.2XXA Other fall from one level to another due to ice and snow, initial encounter
T45.4X3 Poisoning by iron and its compounds, assault
W92.x18 Exposure to excessive heat of man-made origin, initial encounter, Contact with hot metals
X97 Assault by smoke, fire and flames
L64.8 Other androgenic alopecia
W45.0 Nail entering through skin
S91.331A Puncture wound without foreign body, right foot, initial encounter
Brief aside from grievous bodily injury GIFs to repeat what my dad said to me after we saw Home Alone in theaters: “you know not to try any of this at home right?”
J30.89 Allergic rhinitis due to feathers
Z18.81 Retained glass fragments
R46.1: Bizarre personal appearance
W30 fall involving recreational machinery
T65.6X3A Toxic effect of paints and dyes, not elsewhere classified, assault, initial encounter
T65.6X3D Toxic effect of paints and dyes, not elsewhere classified, assault, subsequent encounter
T63.303A Toxic effect of unspecified spider venom, assault, initial encounter
F40.210 Arachnophobia
W22.8 Striking against object, wall 
Y30.XXXA Falling, jumping or pushed from a high place, undetermined intent, initial encounter
Just when you think Kevin has messed up and been caught, he’s saved by his neighbor Ulysses S Grant:

Z59.2 Discord with neighbors
W27.8 Contact with other non- powered hand tool
Y35 Legal intervention
Z63.71 Stress on family due to return of family
And of course:
S03.02 Dislocation of tooth
Anyway, if you are still here I hope you enjoyed the ICD10 version of Home Alone.

This ought to have been worth 1.0 CME credit

I’m open to suggestions for next years movie

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More from @nickmmark

23 Dec
More good news! FDA authorizes another oral COVID treatment today: molnupiravir

A short 🧵 about how molnupiravir (MOLN) works & how/when to use it.

1/
fda.gov/news-events/pr…
Molnupiravir is a pro-drug that is converted to the ribonucleoside analog N4-hydroxycytidine (NHC).

Phosphorylated NHC is incorporated into SARS-CoV-2 RNA by the viral RNA polymerase. This causes many mutations in the virus (“viral error catastrophe”), preventing replication.
2/
But wait aren’t mutations bad? Isn’t Omicron a bunch of mutations that make it more infectious?

The distinction is the *number* of mutations.

RNA viruses are error prone - accumulating on average 1-5 mutations with every copy.

MOLN induces many DOZENS of mutations at once.
3/
Read 18 tweets
18 Dec
Yesterday I gave grand rounds lecture at @NJHealth about the Omicron Variant: molecular biology, epidemiology, and clinical pearls.

Here's the video & link to download my slides.
🎥
📂 onepagericu.com/blog/grand-rou…
Google says AH-MUH-KRAN is 🇺🇸 & OH-MU-KRON is 🇬🇧
Oversimplified..

In ancient Greek, there were 2 letters pronounced similarly:
Ω made a long Oooo - it was called big O or O Mega
Ο made a short Oo - it was called little O or O Micron

Thus, OH-MI-KRON is probably more accurate
2/ Image
To understand Omicron, we need to understand pandemic surveillance:

A sick person 🤒 gets COVID tested.
The (+) results get sequenced (depending on where in the 🌎 ) & published to @GISAID (or other platform).
Sequences are used by researchers globally, such as @nextstrain.
3/ Image
Read 9 tweets
27 Nov
There’s a new SARS-CoV-2 variant of concern: Omicron (aka B.1.1.529) #OmicronVariant

What is this Omicron COVID variant & is the panic of it justified? (spoiler alert: no)

A short #OmicronExplainer 🧵 about what we actually know, what we suspect, & what’s still unknown.
1/
4 reasons Omicron is worrisome:
1️⃣ it is spreading rapidly in South Africa (known)
2️⃣ it is highly mutated (known)
3️⃣some mutations likely increase transmissibility (suspected)
4️⃣others *may* allow it to evade existing immunity or vaccines (unknown)

We’ll talk about all 4...
2/
First some nomenclature:
B.1.1.529 (its Pango lineage) is the same as “Omicron" (WHO declared it a variant of concern & assigned a Greek letter) #OmicronVariant
It’s also known as K21 (Nextstrain clade)

It’s erroneously been called the #NuVariant ... yeah that’s not a thing
3/
Read 16 tweets
9 Nov
Medicine has thousands of eponyms. Most are named for doctors but a few eponyms honor patients.

For example, Bacitracin, named for the bacteria Bacillus subtilis var Tracy, was first identified in a little girl “Tracy I.”

New post & medical history🧵
1/
onepagericu.com/blog/magnanimo…
Hieronymus Karl Friedrich Freiherr von Münchhausen, a German Baron, was legendary for telling stories of his adventures in the Russian Cavalry during the Russo-Turkish War.
(even the dogs look entertained!)
Notably he was *NOT* regarded as a liar but as a great story-teller!
2/
A German writer & con-artist, Rudolf Erich Raspe, created a fictional character Baron Munchausen loosely based on Baron Münchhausen (note the spelling: u not ü)

Munchausen had incredible adventures such as riding a cannonball, fighting a 40 foot crocodile, & going to the Moon
3/
Read 23 tweets
5 Nov
💊Exciting news today about another oral therapy for early COVID: reduced hospitalization & mortality.

Here’s a Deep dive 🧵 on the new PF-07321332 protease inhibitor (“Paxlovid”) & the very impressive results announced from the EPIC-HR trial.
TL/DR: this is a big deal.
1/
What the heck is PF-07321332?

All coronaviruses produce a polypeptide that must be cleaved by a protease into 11 proteins. Without this protease the virus can’t co-opt cellar machinery & reproduce.

PF-07321332 Inhibits the viral main protease (Mpro).
2/

pdb101.rcsb.org/motm/242
Specifically PF-07321332 binds to the catalytic site of Mpro.

Mpro is a great target because there are unique features of Mpro not found in *any* human enzymes & because spike protein mutations wouldn’t confer resistance.

In short, an ideal drug🎯
3/

medrxiv.org/content/10.110…
Read 15 tweets
3 Nov
🚨Results of the #ITECH RCT in Malaysia 🇲🇾 are in & it’s yet another NEGATIVE result for ivermectin:
-n=500 high risk outpatients w/COVID randomized to 0.4 mg/kg IVM x5 days vs SOC
-no difference in rate of progression or time to recovery
-3x more adverse events w/ ivermectin
1/ Image
I-TECH was an open label RCT of IVM (0.4 mg/kgx5 days) vs standard of care (SOC)

It enrolled high risk outpatients (>50 yo w/ ≥ 1 comorbidity) w/in 7 days of COVID symptoms

In summary, HIGH risk pts given HIGH dose IVM EARLY & adequately powered 🤔
clinicaltrials.gov/ct2/show/NCT04…
2/ ImageImageImageImage
We don’t have the full results yet but based on the 🇲🇾 Ministry of Health data this was a NEGATIVE trial.
- IVM recipients did numerically worse: 21.2% progressed to severe disease vs 17.9% receiving SOC (OR 1.29 CI 0.8-2.0)
- time to progression was similar: 2.9 vs 3 days
3/ Image
Read 8 tweets

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