Adding color to ICD-10 codes

Struck by an orca whale? There’s an International Statistical Classification of Disease and Related Health Problems, 10th revision (ICD-10)code for that.

What began as a search for the obscure, outlandish and outrageous among friends has grown into a viable family business. ICD-10 Illustrated is a publishing company that offers a funny look at the obscure and outrageous medical codes founded by Niko Skievaski and run by his mom and dad.

"They moved (to Madison) right when the book started and my dad was still looking for a job, so I said 'Well, why don’t you help package books until this book thing doesn’t make sense anymore,'" Skievaski says. "I thought we would have a little spike for Christmas and then it would be gone." 

That was in October 2013. The company is still going strong, thanks in part to ICD-10 finally being implemented in October 2015. ICD-10 Illustrated has published "Struck by Orca," a book illustrating the medical codes. The company has since branched out to produce posters, playing cards and presentation slide deck art.

The idea began with a bunch of health IT nerds enjoying the Wisconsin Chamber Orchestra one warm summer Wednesday night. Wine was poured, and the conversation flowed, as it often does, to ICD-10 codes. People whipped out their phones to find the funniest codes. Someone said they should make a book them. The idea faded once the music and the buzz did, too.

But a friend brought up the idea to Skievaski a few months later and offered to contribute a piece of art. Skievaski, president and co-founder of REDOX, built a website landing page for preorder to see if it was a viable idea—and enough people were interested.

"When we started the company, we didn’t know if anyone would want to buy the book," Skievaski says. "Initially, we thought it would just be a few people who worked in healthcare technology. But, in fact, the market was much bigger. We were getting doctors, nurses, administration and support staff. Basically, anyone who worked in the healthcare system was interested. Even before we had a product we had sold a 1,000 copies."

James Lloyd, contributing artist and co-founder/CTO of REDOX, says it’s easy to understand why the idea struck a chord. "It’s easy to find yourself in a situation where you’re saying 'I don’t know why I’m doing this,'" Lloyd says. "(The coding process can be) pretty painful, and there’s a lot of monotony and regulation. It’s important to take a step back and be able to laugh at the scenario, laugh at yourself and turn it into something you can have fun with. I think that’s the opportunity here."

Skievaski realized it would be easier to have a lot of people create one or two pieces of art for "Struck by Orca," which was convenient because he only had a couple months before he needed to go to the printer, Tim, down the street.

So, he decided to crowdsource the art from his own network. Before starting REDOX, Skievaski co-founded 100state, a co-working space in Madison. His initial call for art went to members of 100state. Then he reached out to his contacts on LinkedIn, followers on Twitter and friends on Facebook. The first edition was filled with artists who knew Skievaski or were a friend of a friend.

Skievaski sent out a spreadsheet of some obscure codes to artists, who chose their code first-come, first-served. Jon Lyons, a Chicago-based artist and stand-up comedian, illustrated "Toxic effect of venom of bees, intentional self-harm" and "Prolonged stay in weightless environments."

"They’re such unusual topics, and it makes you think about the way we organize the healthcare system that we have these codes," Lyons says. "Well, surely, there are all sorts of other crazy accidents that we never hear about. Who’s living those lives?"

Just as the artists are allowed to choose and interpret the code however they wish, from concrete to abstract, they’re also allowed to illustrate using in their preferred medium. The book is a mix of photography, pencil, markers and digital art. One artist used nail polish, ketchup and coffee grounds to illustrate V91.07xD, "Burn due to water skis on fire, subsequent encounter."

Ellery Addington-White is a full stack developer on ITT for Intuit who illustrated the codes "Struck by Orca" and "Bit by an Orca." He describes his art as unplanned, abstract, psychedelic and over the top, which might seem a contrast to his day job until you hear him talk about the process. 

"To me, the greatest way to be good at anything technical is to come at it from a creative perspective," Addington-White says. "I think some of the most amazing technical innovations are just incredibly creative. I’ve always wondered about the stereotype that creatives are right-brained and technical are left-brained because I try and approach everything like art: You have to come at it from a different perspective because otherwise, you’re just doing the same thing over and over again." 

With the exception of Lyons and a few others, the art for “Struck by Orca” was created mostly by amateurs who work in healthcare IT, not professional artists. That’s part of the book’s appeal, Skievaski says, because it allows people to reconnect with a past hobby and share their work with their peers.

"It’s a pleasure looking through the book and seeing all sorts of things," Skievaski says. "We all had hobbies growing up. For a lot of people, their hobby was making art, so this gets them back to their roots."

Skievaski illustrated the code for "Other contact with grain storage elevator." He photoshopped a man peering over the ledge of a grain silo. He also designed the book, minimally, because his InDesign skills are minimal, he jokes. 


"The book itself is fun," Skievaski says. "The company provides no value in the world other than an outlet for these artists to express themselves and some humor for the people who buy it. We keep the company at that level, too."

It’s a passion. A passion that has sold more than 15,000 books.




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