As day-time temperatures soar, many people are experiencing heat-related disorders, including conditions that are potentially deadly. According to a CBS News report dated July 21, up to 200 million people could be affected from the central U.S. to the East Coast. Heat-related illnesses include a variety of disorders ranging from heat syncope, muscle cramps, heat exhaustion, and heat edema to medical emergencies such as heatstroke and sunstroke. Expert coders can help physicians choose the correct ICD-10 codes to report these conditions based on their signs and symptoms. As emergency physicians focus on their patients, reliable physician billing services can ensure accurate submission of claims to ensure timely insurance reimbursement.
Heat-related Illnesses – Signs, Symptoms and Diagnosis
According to the American Academy of Family Physicians, “Heat-related illness is a physiologic insult that occurs when the body is unable to dissipate heat adequately, which leads to dysfunctional thermoregulation”.
Heat-related disorders are caused by prolonged or intense exposure to hot temperatures. Those at higher risk of a heat-related illness include:
- Babies and children up to four years of age
- Adults age 65 years or older
- Those who are overweight
- Outdoor workers
- Athletes
- People with mental illness, and
- Those with chronic medical conditions or are on certain medications
- Heat exhaustion: Heat exhaustion is caused by overheating of the body through strenuous work or exercise. Over-exertion causes sweating, leading to the loss of large amounts essential fluids, which can affect circulation and brain Without timely treatment, the condition can progress to heatstroke, a life-threatening condition. People who have heart, lung, or kidney problems or are on low-sodium diets face an increased risk of heat exhaustion. Symptoms include: nausea and vomiting, weak, rapid pulse, fatigue, dizziness, headache, muscle cramps, weakness, and excessive sweating.
Diagnosis of heat exhaustion is usually made by taking the patient’s medical history and performing a physical exam. Blood and urine tests, and muscle function tests may be ordered to see if heat exhaustion has progressed to heatstroke. Imaging tests may be conducted to check for damage to internal organs.
- Heat syncope: Heat syncope is a fainting episode brought on by prolonged standing without movement or sudden rising from a sitting or lying position in high environmental temperatures. It is caused by inadequate blood flow to the brain, causing the person to faint. Factors that may lead to heat syncope include dehydration and lack of acclimatization to heat. Symptoms include: fainting (short duration), dizziness, and wooziness during prolonged standing or suddenly rising from a sitting or lying position.
- Heat cramps: Heat cramps occur in people who work, exercise, or are active in a hot environment. These painful, involuntary muscle spasms are caused by heavy exercise or heat exhaustion that leads to fluid and electrolyte loss. Symptoms of heat cramps include profuse sweating with involuntary spasms of the large muscles in the body.
Heat cramps can involve any muscle that is overworked in a hot environment, but typically affects the major muscles such calves, arms, abdominal wall and back. Risk of heat cramps is higher in individuals with compromised temperature control mechanisms, such as infants, young children, and the elderly.
Symptoms of heat cramps include profuse sweating with involuntary spasms of the large muscles in the body. To diagnose the condition, the physician will review the patient history and identify the muscle groups that are in spasm.
- Heatstroke: Heatstroke is the most serious of the heat-related illnesses and can develop quickly. It is caused by long, intense exposure to heat. The body loses its ability to cool itself and overheats to a temperature of 40°C (104°F) or higher. Heatstroke requires emergency treatment. If not addressed quickly, the condition can affect the brain, heart, kidneys and muscles.
There are two types of heatstroke: classic and exertional. Classic heat stroke is caused by a heat wave or very hot weather. Infants, elderly people, and patients with chronic health concerns and diagnoses are more vulnerable to classic heatstroke. Exertional heatstroke is brought on by strenuous and/or continual exercise in a hot indoor or outdoor setting. It typically affects those who are physically active such as athletes, military recruits, and factory workers. The condition may recur in people who have had a heatstroke previously.
Typical symptoms include:
- High body temperature: Body temperature of 104 F (40 C) or higher
- Confused state of mind/behavior: This can include agitation, slurred speech, irritability, delirium, seizures and coma
- Changes in sweating: In heatstroke caused by hot weather, the skin will feel hot and dry to the touch
- Nausea and vomiting
- Flushed skin.
- Rapid breathing.
- Increased pulse rate
- Headache
Diagnostic studies for heat stroke include rectal temperature for obtaining core body temperature, serum electrolytes, CBC, and liver function tests (LFTs). Cranial CT scan, lumbar puncture (LP), and blood culture may also be considered.
ICD-10 Codes for Heat-related Disorders
The ICD-10 comparable codes for heat-related disorders are found in Chapter 19 (Injury, Poisoning, and Certain Other Consequences of External Causes) under category T67 (Effects of heat and light) and in Chapter 20 (Exposure to forces of nature – X30-X39).
- 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
- X30 Exposure to natural excessive heat
These codes require a seventh character to note the encounter type; A, initial encounter; D, subsequent encounter, and S, sequel. Two X placeholders will be necessary in order to complete the code. For example, initial encounter for heat stroke and sunstroke in ICD-10 will be reported using code T67. 0XXA.
The ICD-10 codes in category T67 have both Excludes1 and Excludes2 notes. The Excludes1 codes are conditions that should never be reported with the codes for heatstroke:
- Erythema (dermatitis) ab igne (L59.0)
- Malignant hyperpyrexia due to anesthesia (T88.3)
- Radiation-related disorders of the skin and subcutaneous tissue (L55-L59)
The Excludes2 conditions may occur at the same time as codes from category T67 and can be reported separately. The Excludes2 notes are:
- Burns (T20-T31)
- Sunburn (L55.-)
- Sweat disorder due to heat (L74-L75)
For coders to provide the correct codes, physicians should accurately document the symptoms and assessment of the heat-related illness and provide a definitive diagnosis. While dizziness, nausea and vomiting, fatigue, and headache are signs of heat-related illness, these could also be indicative of a different diagnosis.
With large numbers of people seeking medical help for a heat-related illness, emergency departments are under a lot of pressure. As physicians deal with the heat emergency, they can rely on an experienced medical billing company to report the heat-related disorders correctly and submit error-free claims.
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