I originally wrote this back in 2014, but still relevant, due to the heat-wave that has been on the rise here in Idaho.... Please be safe my friends, and enjoy! :)
Master coding for heatstroke and related diagnoses in ICD-9-CM and ICD-10-CM
By Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC, CDIP,
AHIMA approved ICD-10cm/pcs training.
AHIMA approved ICD-10cm/pcs training.
Summer and hot weather bring a variety of sun and heat-related illnesses to the forefront of a quick-care or urgent care practice. Coders will need to discern the differences between the signs and symptoms of heat stroke, sunstroke, and other heat-related illnesses in order to choose the correct code in both ICD-9-CM and ICD-10-CM.
The following ICD-9-CM codes, located in category 992, are used to report heat- and light-related signs and symptoms:
• 992.0, heat stroke and sunstroke
• 992.1, heat syncope
• 992.2, heat cramps
• 992.3, heat exhaustion, anhydrotic
• 992.4, heat exhaustion due to salt depletion
• 992.5, heat exhaustion, unspecified
• 992.6, heat fatigue, transient
• 992.7, heat edema
• 992.8, other specified heat effects
• 992.9, unspecified effects of heat and light
These ICD-9-CM codes are separated into a specifically denoted code set for the effects of heat and light in Chapter 17 (Injury and Poisoning), rather than grouped into Chapter 16 (Symptoms, Signs, and Ill-Defined Conditions).
In ICD-10-CM, comparable codes are located in Chapter 19 (Injury, Poisoning, and Certain Other Consequences of External Causes) under category T67 (Effects of heat and light). The ICD-10-CM codes include:
• T67.0-, heatstroke and sunstroke
• T67.1-, heat syncope
• T67.2-, heat cramp
• T67.3-, heat exhaustion, anhydrotic
• T67.4-, heat exhaustion due to salt depletion
• T67.5-, heat exhaustion, unspecified
• T67.6-, heat fatigue, transient
• T67.7-, heat edema
• T67.8-, other effects of heat and light
• T67.9-, effect of heat and light, unspecified
These codes require a seventh character to note the encounter type, using one of the following options:
• A, initial encounter
• D, subsequent encounter
• S, sequela
Coders will need to use two X placeholders in order to complete the code. For example, to report an initial encounter for heat edema in ICD-10-CM, use code T67.7XXA.
The current ICD-9-CM and ICD-10-CM draft codes for these diagnoses are nearly identical in the information they report, even though the codes look very different.
Heatstroke and sunstroke
A patient suffers heatstroke when the body's temperature rises too high as a result of excessive heat exposure. In essence, the body loses its ability to cool itself and overheats. Heatstroke can have a quick onset in severe conditions and situations, especially with extreme physical exertion or exercise. Heatstroke can happen rather quickly, especially if the person becomes dehydrated.
Heatstroke is classified into two separate categories:
• Classic heatstroke: This can occur during a heat wave or very hot weather. Babies, seniors, and patients with chronic health concerns and diagnoses are more susceptible to classic heatstroke than the rest of the population because their ability to thermoregulate is already decreased.
• Exertional heatstroke: This can occur as a result of physical exertion, such as strenuous and/or sustained exercise in a hot environment (indoors or outdoors). Exercise or exertional heatstroke can affect any age group, but tends to affect more physically active people and children, teens, and young adults more than sedentary or older individuals. This is a very common risk, especially for athletes, firefighters, and military personnel that are subject to varied circumstances. Interestingly, patients who have had a heatstroke previously are considered at high risk for recurrence, as the body’s thermoregulation system has already been compromised by the drastic effects of a heatstroke.
The signs and symptoms of a heatstroke can occur individually or as a combination. According to the National Health Service (UK) the following symptoms are some, but not all, of the most commonly identified symptoms seen in heatstroke cases:
• Profuse sweating that abruptly stops
• Accelerated or weak heartbeat
• Hyperventilation with rapid breathing and/or shallow panting
• Muscle cramps
• Skin that is hot, dry, and/or red
• Nausea and/or vomiting
• Sudden headache
• Mental confusion, irrational behavior
• Reduced and/or loss of muscle coordination
• Dizziness, vertigo, lightheadedness, syncope
• Loss of consciousness
• High core body temperature, typically 102°F or higher
Prolonged sun exposure in high temperatures and high humidity, as well as extremely hot or dry weather conditions, can contribute to the risk of a heatstroke. Rapid dehydration and the body’s sweat response make heatstroke a very real possibility.
The weather heat index give us an idea of how the high levels of heat/humidity/dryness affect the body:
• 80°F-90°F, fatigue possible after physical activity or sun exposure
• 90°F-105°F, heat exhaustion, heat cramps, and sunstroke possible after prolonged physical activity or sun exposure
• 105°F-130°F, heat exhaustion, heat cramps, and sunstroke likely after prolonged physical activity or sun exposure
• 130°F and higher, sunstroke likely with sustained exposure to the sun
The media has played an important role in bring heat-related illness/heatstroke to the forefront, especially for young children, the elderly, and animals. Just a few degree increase in temperature can quickly bring on symptoms of a heatstroke.
When coding for actual heatstroke cases, coders need to carefully review the provider documentation. We can only code what we know. If the provider does not specifically diagnose the patient with heatstroke, but only documents the compilation of symptoms, then we should only code those symptoms. We cannot jump to the “association” of the patient's symptoms to the definitive diagnosis of “heatstroke.”
In ICD-9-CM the guidelines also tell us to “use additional codes” to identify any other associated complications, such as:
• Alterations of consciousness (780.01-780.09)
• Systemic inflammatory response syndrome (995.93-995.94)
Coders should also be aware of the Excludes notes:
• Burns (940.0-949.5)
• Diseases of sweat glands due to heat (705.0-705.9)
• Malignant hyperpyrexia following anesthesia (995.86)
• Sunburn (629.71, 692.76-692.77)
For example, sunburn is reported with its own diagnosis codes and would need to be coded separately in addition to heatstroke.
The ICD-10-CM codes in category T67 have both Excludes1 and Excludes2 notes. The Excludes1 codes are:
• Erythema (dermatitis) ab igne (L59.0)
• Malignant hyperpyrexia due to anesthesia (T88.3)
• Radiation-related disorders of the skin and subcutaneous tissue (L55-L59)
These conditions should never be reported with the codes for heatstroke.
The Excludes2 notes are:
• Burns (T20-T31)
• Sunburn (L55.-)
• Sweat disorder due to heat (L74-L75)
The Excludes2 conditions may occur at the same time as codes from category T67 and can be reported separately.
ICD-10-CM also contains similar instructions to ICD-9-CM for using additional codes to identify associated complications when reporting heatstroke and sunstroke (T67.0-):
• Coma and stupor (R40.-)
• Systemic inflammatory response syndrome (R65.1-)
Physicians will need to explicitly state “heatstroke” as a definitive diagnosis, and not just denote these signs and symptoms presented by the patient in their documentation.
Editor’s note: Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC, and ICD-10-CM/PCS trainer is an E/M and procedure-based coding, compliance, data charge entry, and HIPAA privacy specialist, with more than 20 years of experience. Lori-Lynne’s coding specialty is OB/GYN office/hospitalist services, maternal fetal medicine, OB/GYN oncology, urology, and general surgical coding. She can be reached via e-mail at firstname.lastname@example.org or you can also find current coding information on her blog: http://lori-lynnescodingcoachblog.blogspot.com/.