D. T67.0XXA, R65.11, N17.9

The diagnoses are specified as heatstroke and SIRS with acute kidney failure.

To locate heatstroke in the ICD-10-CM coding manual, look up Heat (effects), stroke T67.0. Verifying this code in the Tabular, T67.0 Heatstroke and sunstroke also refers to:

  • Heat apoplexy
  • Heat pyrexia
  • Siriasis
  • Thermoplegia

See the instructional note at T67 that lets us know we need a 7th character (A-initial encounter; D-subsequent encounter; S-sequela). The patient is receiving active treatment and is being seen for an initial encounter. Therefore, we should assign T67.0XXA (Heatstroke and sunstroke, initial encounter).

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.-)
  • systemic inflammatory response syndrome (R65.1-)

The documentation indicates the patient has SIRS (systemic inflammatory response syndrome). Looking up R65.1- in the Tabular, there are two codes listed which include:

  • R65.10 for SIRS of non-infectious origin without acute organ dysfunction
  • R65.11 for SIRS of non-infectious origin with acute organ dysfunction

The correct code is R65.11, Systemic inflammatory response syndrome (SIRS) of non-infectious origin with acute organ dysfunction. The documentation specifies there is acute kidney failure, which is the acute organ dysfunction.

There are two notes to see at R65.11:

  • The “use additional” note tells us to assign the specific acute organ dysfunction, such as acute kidney failure (N17.-). In the Tabular, N17.9  refers to Acute kidney failure, unspecified, which is the correct code.
  • The “code first” note lets us know that the code for heatstroke (underlying condition) needs to be sequenced before the code for the SIRS.

Hence, our answer is D. T67.0XXA, R65.11, N17.9

A, B, and C are incorrect.

A. R65.11, T67.0XXA, N18.9.  The sequencing is incorrect (as explained above), and N18.9 refers to Chronic kidney disease, unspecified.

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

C. R65.10, N17.9, T67.0XXA.  Incorrect sequencing and R65.10 refers to Systemic inflammatory response syndrome (SIRS) of non-infectious origin without acute organ dysfunction.

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

How Did You Do?

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

If you were on the right track but got a little confused at some point, no worries. Keep working 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

SIRS is generally related to infection, but when it is caused by a non-infectious problem such as heatstroke, Medscape reports that it is characterized as 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 is a condition that develops quickly where the kidneys cannot filter waste from the blood.

Tips For Taking a Timed Exam

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

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

  1. Look at the answers first.
  2. All four answers include T67.0XXA, but this code is not sequenced in the same order in every answer. So, I would look up that code in the Tabular and review any instructional notes.
  3. The instructional notes at T67.0 tell us that the underlying condition (heatstroke) should be sequenced first, followed by the complication (SIRS). This is evident by the “use additional”note.
  4. Going to R65.1-, we can see that R65.11 is the correct code. There is also a “code first” note at R65.1 to indicate T67.0 comes before R65.11.
  5. So we have our first two codes: T67.0XXA, R65.11.
  6. That eliminates A, B, and C right away, leaving us only with D.
  7. I would not even bother to look up the code for acute kidney failure on a timed exam because the instructional note at R65.11 indicates that acute kidney failure is coded to N17.-.

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 and move on, and if time permits, come back to it later. Taking a timed exam is not like everyday coding.

FY 2020 Code Changes

As of October 1, 2019, the codes for heatstroke will change, as explained below.