How Villain Deaths in James Bond Movies Would Be Coded under ICD-10

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Similar to other healthcare professionals, I have been required to use ICD-10 codes for the past several months. Unfortunately, I have been unable to discern any improvement in my patient care, but perhaps I have not used the codes long enough. Certainly, healthcare administrators and statisticians assure me there are several advantages of ICD-10 over ICD-9. It only recently occurred to me—while I was reading a synopsis of the movie, Spectre—that one of these advantages is undoubtedly the more specific coding that can be applied to villain deaths occurring in James Bond (007) movies.

ICD Over the Years

England, the location of MI6 headquarters, has participated in disease classification systems since 1860, when Florence Nightingale made a proposal at an international statistical conference held in London that such a classification system should be developed.

In the 1890s, a French physician, Jacques Bertillon, chaired a committee that synthesized the first classification system of the causes of death that was agreed upon by multiple countries in 1900 at the first International Conference for the Revision of the Causes of Death. At this conference, a parallel classification of nonfatal diseases for statistical use was also adopted.

Approximately every 10 years, these classification systems were revised and updated. By the time of the fifth revision conference, in 1938, the lists for nonfatal diseases and causes of death were combined, and 380 specific disease categories were recorded.

In 1948, at the sixth revision conference, the name was changed from the International List of Causes of Death to the International (Statistical) Classification of Diseases (ICD-6), and in 1955, the World Health Organization took over the maintenance and revision of ICD. By 1975, the ninth revision (ICD-9) expanded the disease classification codes to 13,000, with each code being three to five characters long.

Enter 007

At the time of the adoption of ICD-9 in 1978, 10 of the 24 James Bond movies had been produced. With a “license to kill,” James Bond dispatched many villains—often in weird and unusual ways. Perhaps it is just coincidence, but at about this same time, ICD-9 was felt to be inadequate, and the need for ICD-10 was discussed.

Imagine the difficulty that a coder in 1981 would have had accurately coding the death of the villain in For Your Eyes Only, who dies by being dropped into an industrial chimney in a motorized wheelchair!

ICD-11 has already been written & is expected to be approved & implemented in 2018. The specificity of ICD-11 will certainly be greater, with each ICD category being described by 13 main parameters.

So in 1983, work began on ICD-10, and 68,000 codes—each three to seven characters long—were developed, adopted and—by 1994—used by most nations. The U.S. used abbreviated ICD-10 mortality codes starting in 1999, but did not fully embrace all ICD-10 coding until 2015.

Now, the coders of all nations can accurately code the deaths occurring in James Bond movies:

1. Goldfinger (1964): Asphyxiation due to gold paint.
   Code T65.6X3S, Toxic effect of paints and dyes, not elsewhere classified, assault, sequela.
2. Goldfinger (1964): Sucked out of depressurized airplane cabin.
   Code T70.8XXS, Other effects of air pressure, sequela.
3. Live and Let Die (1973): Kanaga’s overinflation death.
   Code T70.8, Blast (air) injury syndrome, NEC.
4. For Your Eyes Only (1981): Dropped into an industrial chimney in a motorized wheelchair.
   Code: X02.0XXS, Exposure to flames in controlled fire in building or structure, sequela.
5. Octopussy (1983): Snuffed by a poisonous octopus to the face.
   Code: T63.593S, Toxic effect of contact with other venomous fish, assault, sequela.
6. Octopussy (1983): Punctured on bed of nails.
   Code S21.94XS, Puncture wound with foreign body of unspecified part of thorax, sequela.
7. The Living Daylights (1987): Crushed by a bust of the Duke of Wellington.
   Code: S07.9XXS, Crushing injury of head, part unspecified, sequela.
8. License to Kill (1989): Mangled by a giant cocaine shredder.
   Code W30.89XS, Contact with other specified agricultural machinery, sequela.
9. License to Kill (1989): Sealed in a drawer full of maggots.
   Code B87.9, Myiasis, unspecified.
10. GoldenEye (1995): Frozen by liquid nitrogen.
    Code W93.11XS, Exposure to liquid nitrogen, sequela.
11. Tomorrow Never Dies (1997): Mauled by a sea drill.
    Code: W31.0XXS, Contact with mining and earth-drilling machinery, sequela.
12. Skyfall (2012): Chomped by a Komodo dragon.
    Code: W59.01XS, Contact with non­venomous lizards, sequela.

As aggravatingly complete as ICD-10 seems to be, it is still not precise enough. Indeed, the code T70.8XXS, Other effects of air pressure, sequela does not fully describe a situation in which someone is sucked out of a depressurized airplane cabin. And God knows we need an accurate code for that.
Not to worry, ICD-11 has already been written and is expected to be approved and implemented in 2018. The specificity of ICD-11 will certainly be greater, with each ICD category being described by 13 main parameters. Isn’t that great?

Sterling G. West, MD, MACP, MACR, is professor of internal medicine and associate rheumatology division head for clinical affairs at the University of Colorado School of Medicine in Aurora, Colo. He was the previous Rheumatology Fellowship Program Director for over 30 years. He has published more than 100 articles and is editor of the book, Rheumatology Secrets.

Editor’s Note

ACR staff is available to assist with ICD-10 questions.