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Coding for Heatstroke and SIRS With Kidney Failure in ICD-10-CM

heatstroke and SIRS with kidney failure in ICD-10-CM
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The Coding Challenge

Question: A 29-year-old male is admitted for treatment of heatstroke after playing volleyball on the beach for many hours. The final diagnosis is heatstroke and SIRS with acute kidney failure. Assign for ICD-10-CM.

A. R65.11, T67.01XA, N18.9, Y93.13
B. T67.01XA, A41.9, N17.8, Y93.68
C. R65.10, N17.9, T67.01XA, Y93.13
D. T67.01XA, R65.11, N17.9, Y93.68


D. T67.01XA, R65.11, N17.9, Y93.68

The diagnoses are specified as heatstroke and SIRS with acute kidney failure. SIRS stands for systemic inflammatory response syndrome. Heatstroke is a serious matter that can lead to SIRS and organ dysfunction. It can even be fatal. You can learn more about this condition at the bottom of this post.

Locate and Verify

Heatstroke (T67.01-)

To locate heatstroke in the ICD-10-CM coding manual, look up Heat (effects)/stroke T67.01. When we go to this code in the Tabular, we can see that there is a 7th character required for T67.01 to indicate the episode of care. The patient is receiving active treatment and is being seen for an initial encounter. Therefore, we should assign T67.01XA (Heatstroke and sunstroke, initial encounter).

According to the ICD-10-CM Official Guidelines for Coding and Reporting:

“7th character “A” initial encounter is used for each encounter where the patient is receiving active treatment for the condition. 7th character “D” subsequent encounter is used for encounters after the patient has completed active treatment of the condition and is receiving routine care for the condition during the healing or recovery phase. 7th character, “S,” sequela, is for use for complications or conditions that arise as a direct result of a condition, such as scar formation after a burn. The scars are sequelae of the burn.”

ICD-10-CM codes for heatstroke and sunstroke including T67.01XA, T67.01XD, and T67.01XS.

Inclusion terms listed under T67.01 (Heatstroke and sunstroke) are:

  • Heat apoplexy
  • Heat pyrexia
  • Siriasis
  • Thermoplegia

There is also a “use additional” note indicating that we need to assign a code to identify any associated complications of heatstroke, such as:

  • coma and stupor (R40.-)
  • rhabdomyolysis (M62.82)
  • systemic inflammatory response syndrome (R65.1-)

Note that systemic inflammatory response syndrome, or SIRS, is one of the diagnoses provided in this coding scenario.

SIRS (R65.1-)

Looking up R65.1- in the Tabular, there are two codes listed, which include:

  • R65.10 SIRS of noninfectious origin without acute organ dysfunction
  • R65.11 SIRS of noninfectious origin with acute organ dysfunction

The correct code is:

R65.11, Systemic inflammatory response syndrome (SIRS) of noninfectious origin with acute organ dysfunction

The acute organ dysfunction is kidney failure.

A “Use additional” note instructs the coder to assign a code for the specific acute organ dysfunction, such as:

  • acute kidney failure (N17.-)
  • acute respiratory failure (J96.0-)
  • critical illness myopathy (G72.81)
  • critical illness polyneuropathy (G62.81)
  • disseminated intravascular coagulopathy [DIC] (D65)
  • encephalopathy (metabolic) (septic) (G93.41)
  • hepatic failure (K72.0-)

We need to go to N17.- in the Tabular.

Acute Kidney Failure (N17.-)

When looking at our code options under N17.-, we can see the correct code is:

N17.9 – Acute kidney failure, unspecified
Acute kidney injury (nontraumatic)

An Excludes2 indicates if traumatic kidney injury (S37.0-) is documented, it should also be reported. There is no mention of a traumatic kidney injury.

A “Code Also” note at N17 instructs us to assign a code for the associated underlying condition.

There are also Excludes1 and Excludes2 notes that you will want to review before making your final code selection.

As far as sequencing guidelines are concerned, the ICD-10-CM coding guidelines state, “When SIRS is documented with a noninfectious condition, and no subsequent infection is documented, the code for the underlying condition, such as an injury, should be assigned, followed by code R65.10, Systemic inflammatory response syndrome (SIRS) of noninfectious origin without acute organ dysfunction, or code R65.11, Systemic inflammatory response syndrome (SIRS) of noninfectious origin with acute organ dysfunction. If an associated acute organ dysfunction is documented, the appropriate code(s) for the specific type of organ dysfunction(s) should be assigned in addition to code R65.11.”

The underlying condition is heatstroke (T67.01XA), which is sequenced first, followed by R65.10 for SIRS, and then N17.9 for the organ dysfunction or kidney failure.

External Cause Code (Y93.6-)

The patient was playing volleyball on the beach at the time of the heatstroke. Therefore, we need to assign an external cause code for this activity. To find the code in the Index of External Causes, look up Activity (involving) (of victim at time of event)/ beach volleyball, and it takes us to Y93.68. In the Tabular, we can verify our code as:

Y93.68, Activity, volleyball (beach) (court)

External cause codes help tell the story of the encounter and should never be assigned as a first-listed or principal diagnosis.

The correct answer to the coding challenge is D. T67.01XA, R65.11, N17.9, Y93.68

Incorrect Answers

A, B, and C are incorrect.

A. R65.11, T67.0XXA, N18.9, Y93.13. The sequencing is incorrect (as explained above), and N18.9 refers to Chronic kidney disease, unspecified. Y93.13 is assigned for the Activity of water polo.

B. T67.0XXA, A41.9, N17.8, Y93.68. A41.9 refers to Sepsis, unspecified organism, and N17.8 describes Other acute kidney failure.

C. R65.10, N17.9, T67.01XA, Y93.13. Incorrect sequencing and R65.10 refers to Systemic inflammatory response syndrome (SIRS) of noninfectious origin without acute organ dysfunction. Again, Y93.13 is incorrect.

Remember to read all instructional notes, including Excludes1 and Excludes2, code first, and use additional before assigning the appropriate code(s).

How Did You Do?

If you aced the coding challenge, I’m impressed! Yay!! Yippee!! Congratulations!

No worries if you were on the right track but got confused along the way. Keep working on it until you can do it without missing a beat.

“Successful men and women keep moving. They make mistakes, but they don’t quit.” – Conrad Hilton

About These Conditions


Heatstroke is the most severe type of heat injury and is described as a body temperature higher than 104°F, which is associated with neurologic dysfunction, according to Medscape. It is considered a medical emergency and can start as heat stress and progress to heatstroke, systemic inflammatory response syndrome (SIRS), multi-organ dysfunction syndrome (MODS), and can even lead to death.

The signs and symptoms of heatstroke, as reported by WebMD, include:

  • A body temperature elevated above 104°F
  • Dehydration
  • Throbbing headache
  • Dizziness and light-headedness
  • Lack of sweating despite the heat
  • Red, hot, and dry skin
  • Muscle weakness or cramps
  • Nausea and vomiting
  • Rapid heartbeat, which may be either strong or weak
  • Rapid, shallow breathing
  • Behavioral changes such as confusion, disorientation, or staggering
  • Seizures
  • Unconsciousness

Systemic Inflammatory Response Syndrome (SIRS)

SIRS is generally related to infection, but when it is caused by a noninfectious problem such as heatstroke, Medscape reports that it is characterized by two or more of the following conditions:

  • Fever of more than 100.4°F or less than 96.8°F (hypothermia)
  • Heart rate of more than 90 beats per minute (tachycardia)
  • Respiratory rate of more than 20 breaths per minute or arterial carbon dioxide tension (PaCO2) or less than 32 mm Hg (tachypnea)
  • Abnormal white blood cell count (>12,000/µL or < 4,000/µL or >10% immature [band] forms) (leukocytosis)

SIRS due to an infection is reported with sepsis codes.

Acute Kidney Failure

Acute kidney failure is a condition that develops quickly when the kidneys cannot filter waste from the blood.

Tips For Taking a Timed Coding Exam

When taking a timed exam, we don’t have much time to look up each code in the Index. Therefore, you will want to consider some shortcuts to finding the best answer in the given amount of time.

For example, in the above coding scenario, I would go about it this way:

  1. Look at the answers first.
  2. At first glance, I can see that T67.01XA is listed in each answer but in a different order. I can also see that answers A and C have the same “Y” code, and answers B and D have the same “Y” code.
  3. First, I would look up the two “Y” codes in the Tabular: Y93.13 and Y93.68. Based on my knowledge, these are external causes codes, as are “V,” “W,” and “X” codes. But even if I wasn’t aware before looking them up, I would still go to these codes in the Tabular and see that Y93.68 is correct. I would immediately cross out answers A and C.
  4. I would then look up T67.01XA to see what the description is and see if there are any instructional notes that may clue me in as to other codes that may need reporting and in what order. A “Use additional” note tells me to code any associated complications of heatstroke, such as systemic inflammatory response syndrome (R65.1-). Looking in the Tabular, I can see that R65.11 is correct. Answer D is looking like the right answer.
  5. There is a “Use additional” code at R65.11 to code for the specific acute organ dysfunction, such as acute kidney failure (N17.-). Upon reviewing the codes in the Tabular, N17.9 is correct. Now, I am confident that answer D is the best answer to the scenario without bothering to look up A41.9.

You may go about the elimination process in a slightly different way, but I think you get my point. Time is of the essence and can make all the difference between passing and failing. You don’t want to spend too much time on each question. Answer it, move on, and return to it later if time permits. Taking a timed exam is not like everyday coding.

Special Request: If you would like to see more coding challenges like the one above and/or posts with tips and strategies for tackling the questions and answers in a certification exam setting, please let me know in the Comments section below.

coding for heatstroke and SIRS
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