By Tom Still

MADISON – Imagine you’re a doctor with a patient who was bitten by a dolphin. The precise code for reporting that medical calamity is W56.01.

Triaging some poor soul who was sucked into a jet engine? There’s a code for that, to V97.33xD.

Treating someone who was injured by an explosion on board a sailboat? Yep, that’s V93.54xD.

There are also medical reporting codes for “inadequate social skills, not elsewhere classified” (Z73.4), “other contact with shark”(W56.49), “forced landing of spacecraft injuring occupant” (V95.42xA) and, of particular Wisconsin interest, “burn due to water skis on fire” (V91.07xD).

Welcome to the arcane, often humorous and yet entirely serious world of computerized medical codes. These codes are used countless times daily by medical professionals across the United States to classify patient ailments and how much those patients, and their insurers, should pay for a specific treatment.

They’re also used to track medical threats and trends – flu outbreaks, for example – and analyze what treatments actually work and which don’t.

A new set of federal codes, known as I.C.D.-10, will take effect Oct. 1, with 68,000 separate codes for diagnoses and 87,000 more for procedures. That’s compared to about 17,000 total in the current I.C.D-9 code system, which means ailments as “pedestrian on foot injured in collision with roller-skater” (V00.01xD) and “struck by a non-venomous lizard” (w59.02xA) will get their very own codes.

The build-up to I.C.D.-10 is why a group of Madison-based health IT experts and artists combined to produce “Struck by Orca,” an illustrated guide to some of the more obscure and often hilarious situations that have found their way into the federal code.

Niko Skievaski, a former Epic Systems employee who has helped launch the 100state co-working space for entrepreneurs, has sold about 2,000 copies since it was published in November. The idea was born during a light-hearted conversation with other health IT coders and software experts during an outdoor concert on Madison’s Capitol Square, and grew into matching whimsical art with obscure codes.

“I really thought finding the art would be the hard part,”said Skievaski, but once the word began to spread among some of the group’s contacts, enough original art to illustrate about three-dozen or so codes were collected. Often, the artists were other young, health IT professionals who happened to be visual artists on the side.

The result is a 66-page book ( that appeals to medical professionals, coders and others who find the humor in a situation that affects their lives every day. Some health-care groups have ordered bulk copies, there’s a poster and a countdown calendar is in the works. Some copies of “Struck by Orca” have been sold overseas, where I.C.D.-10 is already in place in many countries.

None of this takes away from the fact that the rollout of I.C.D.-10 is causing heartburn in some corners of the U.S. medical profession, where doctors and others are worried about keying in the wrong codes or learning a new system that could take time away from patient care. Others wonder about the botched start to whether the new code system will prompt similar confusion.

Supporters liken it to the introduction of the nine-digit zip code versus the original five-digit code: People who needed to adjust did so.

For his part, Skievaski believes the technology behind I.C.D.-10 will work and sees its overall value in a world in which data-driven medicine is vital to quality of care as well as controlling costs.

“Some of it is the human nature of confronting change,” he said. “But any time regulations change, that can also be an opportunity for entrepreneurs to help solve problems.”

It apparently can also be a great excuse to pull together some techy friends, “crowd-source” some art and have a little fun with a waiting-room book.