Death by Autopsy: Is ICD-10 Taking Too Long?
Jul 8, 2015
by Dr. Jon Elion

While surfing the internet late one night, I read about the strange tale of Washington Irving Bishop, one of the great mentalists of the late 1800s. On May 12, 1889, he was giving a “thought-reading” performance in New York when he suffered a seizure and became unconscious. He recovered and continued his performance, only to suffer a second seizure that again caused him to become unresponsive. He was promptly autopsied, apparently without waiting for the coroner’s permission. Six days later, a report in the famed British medical journal “The Lancet” reported that his “… widow [affirms] that Mr. Bishop was subject to such attacks of catalepsy that he feared premature burial, and had enjoined on his friends that in the case of his supposed death in one of these trances they should defer interment until signs of decomposition set in.” He reportedly carried a note with him explaining this, but the note was not found in time to save him from the autopsy. His death certificate officially read “hysterocatalepsy”, but his wife and mother were not satisfied and pressed charges. The two physicians who performed the autopsy went to trial, but the case ended in a hung jury.

This strange story piqued my curiosity on several fronts. First of all, what the heck is hysterocatalepsy? It is officially defined as “Psychogenic non-epileptic seizure events superficially resembling an epileptic seizure, but without the characteristic electrical discharges associated with epilepsy.” Okay, not much help there. On a whim, I turned to my trusty encoder to see if this still existed in modern coding parlance, and I came up with:

  • ICD9: 780.39 Other Convulsions
  • ICD9: 300.11 Conversion Disorder
  • ICD10: F44.5 Dissociative Convulsions

Interesting, but not very helpful. Then I decided that perhaps this was in fact a case of “Death by Autopsy” (Edgar Allan Poe would have been proud!). Well, that is as hard to prove today as it was in 1889, and the subject does not appear to be covered by my trusty encoder, nor by anything I could find in Coding Clinics.

But I wasn’t done yet. I wondered if, in 1889, would this death have been coded using ICD-1? The relevant history turned out to be rather interesting. In 1853, just as the third cholera pandemic was breaking out, the 1st International Statistical Congress met and passed a resolution requesting the preparation of a uniform classification of causes of death. Things did not move quickly, however, and it was not until 1891 that the International Statistical Institute (successor to the International Statistical Congress), charged a committee with the preparation of a classification of causes of death. The report of this committee was finally adopted in 1893 by the International Statistical Institute, a full 40 years after the process had begun. While it was never called that, for all practical purposes, this was “ICD-1”. Too late to be used for coding poor Mr. Bishop’s death.

So now, every time I get frustrated by the delays in adopting ICD-10, I think back to the strange tale of Washington Irving Bishop; to those who may have rushed in prematurely to perform an autopsy for something that may have just stalled and had not in fact died; to how deadly an autopsy and associated “over-analysis” can be; and to how it took a full 40 years to come up with ICD-1. Put in that perspective, perhaps the adoption of ICD-10 is moving at lightning speed!

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