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So here the question is whether or not the patient objectively has intractable epilepsy in the opinion of the doctor. The determination of intractable migraine, however, relies on the voice of the patient and so is marked as a suspicious designation: |
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| 346 | Migraine | |
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The following fifth-digit subclassification is for use with category 346: |
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| | 0 | without mention of intractable migraine | | 1 | with intractable migraine, so stated | | (ICD-9CM, 80) |
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The laboratory context then is the 'real' context of the disease; the classification serves to reinforce the separation of the patient from ownership of their condition. We should note at this point that we are not arguing that this makes the ICD a tool for evil and oppression. On the contrary. What we are trying to do is work out what kind of a tool it is, what work it does, and whose voice appears in its unfolding narrative. |
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The legal context is often enfolded into the classification system. Thus the classification of blindness takes account of the American system of medical benefits: |
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| 369 | Blindness and low vision | |
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Note: visual impairment refers to a functional limitation of the eye (e.g., limited visual acuity or visual field). It should be distinguished from visual disability, indicating a limitation of the abilities of the individual (e.g., limited reading skills, vocational skills), and from visual handicap, indicating a limitation of personal and socioeconomic independence (e.g., limited ability, limited employment.) |
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The levels of impairment defined in the table on page 92 are based on the recommendations of the WHO Study Group on Prevention of Blindness (Geneva, November 610 1972, WHO Technical Report Series 518), and of the International Council of Ophthalmology (1976). |
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Note that definitions of blindness vary in different settings. |
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For international reporting WHO defines blindness as profound impairment. This definition can be applied to blindness of one eye (369.1, 369.6) and to blindness of the individual (369.0). |
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For determination of benefits in the United States, the definition of legal blindness as severe impairment is often used. This definition applies to blindness of the individual only. |
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| | 369.0 | Profound impairment, both eyes | | | 369.00 | Impairment level not further specified | | | | Blindness: | | | | | NOS according to WHO definition | | | | | both eyes |
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