Excelling in ICD-10-CM Coding for Insect Bites, Poison Ivy, and Heatstroke

Discover the must-watch list for coding bug bites, poison ivy, and heatstroke! Get ICD-10 pointers.

Can you believe it’s already mid-August? While the buzz around 2020 code updates is in the air, let’s not forget about the remaining summer of 2019. How many of these common warm-weather diagnoses have you encountered and coded this year so far?

Verify Venom Before You Report That Bug Encounter

When faced with a patient presenting an insect bite or spider bite, there are several factors to consider before selecting the appropriate code. The ICD-10-CM Index to Diseases and Injuries proves to be a valuable resource to begin your search.

Within the index, you will find multiple subentries under “Bite(s) (animal) (human),” categorized by specific sites such as the ankle. Additionally, there is a separate subentry for “insect,” which confirms that focusing on the site is your optimal approach. It directs you to “See Bite, by site, superficial, insect” for further guidance.

Let’s revisit the ankle subentry example. The index indicates S90.56 for an insect bite (nonvenomous) of the ankle. To accurately code, you’ll need to include a sixth character to specify the ankle and a seventh character to indicate the encounter type (initial, subsequent, or sequela).

Tip: When it comes to coding, differentiating between a nonvenomous insect bite and a venomous spider bite is crucial. A venomous spider bite is coded using a code from the T63.3- range, specifically for the toxic effect of spider venom. To explore further options, refer to the “Venom” entry in the ICD-10-CM Table of Drugs and Chemicals.

Interestingly, for a nonvenomous spider bite, the index directs you to “Bite, by site, superficial, insect” (despite spiders not being insects, which might seem unexpected). This guidance highlights the importance of considering the anatomical site when coding nonvenomous spider bites.

Be Alert for Infections With Poison Ivy Rash

During the summer season, wearing light clothing and engaging in outdoor activities can lead to a higher likelihood of coming into contact with plants that cause rashes.

To accurately code for cases of poison ivy, poison oak, and poison sumac dermatitis, the ICD-10-CM index directs you to L23.7, which corresponds to “Allergic contact dermatitis due to plants, except food.” This code specifically covers these types of dermatitis caused by exposure to poison ivy, poison oak, and poison sumac.

Watch for: Occasionally, dermatitis can spread and result in more significant complications, such as skin infections. To accurately report the encounter, it is advisable to utilize additional ICD-10-CM codes for the documented infections or any other relevant issues. This approach can support the reporting of a higher-level E/M code or procedure code that aligns with the specific nature of the encounter.

Head Off Errors for Heat-Related Diagnoses

Within the ICD-10-CM index, you will find an extensive list of subentries categorized under “Heat (effects).” While the majority of these subentries are classified under T67.- for “Effects of heat and light,” there are a few exceptions to be aware of. Additionally, it’s important to note that there may be some code changes in ICD-10-CM 2020.

Here are the four-character subcategories under T67.- in ICD-10-CM 2019:

–  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.

2020 changes: Currently, T67.0- is divided into three codes, distinguishing between encounter types (initial, subsequent, sequela) but with no further specificity. However, with the effective date of ICD-10-CM 2020 on October 1, 2019, these options will expand, offering more specific codes for better classification.

–  T67.01XA Heatstroke and sunstroke, initial encounter

–  T67.01XD Heatstroke and sunstroke, subsequent encounter

–  T67.01XS Heatstroke and sunstroke, sequela

–  T67.02XA Exertional heatstroke, initial encounter

–  T67.02XD Exertional heatstroke, subsequent encounter

–  T67.02XS Exertional heatstroke, sequela

–  T67.09XA Other heatstroke and sunstroke, initial encounter

–  T67.09XD Other heatstroke and sunstroke, subsequent encounter

–  T67.09XS Other heatstroke and sunstroke, sequela.

Subcategory T67.01- will be appropriate for heat apoplexy, heat pyrexia, siriasis, and thermoplegia, according to a note under that subcategory in the ICD-10-CM 2020 tabular list, available on the CDC ICD-10-CM site.

Beyond T67- codesThe index subentries under “Heat (effects)” that don’t fall under T67.- include these conditions:

  • Burn: L55.9 Sunburn, unspecified
  • Dermatitis or eczema: L59.0 Erythema ab igne [dermatitis ab igne]
  • Prickly or rash: L74.0 Miliaria rubra.

Bottom line: To ensure accurate ICD-10-CM coding throughout the summer and beyond, it’s important to follow a few key steps. Begin by searching the ICD-10-CM index and tables to identify the appropriate codes. Next, confirm your code selection by referencing the ICD-10-CM tabular list. Lastly, stay informed about updates and changes to the diagnosis codes relevant to your patients. By staying proactive and thorough in your coding process, you can maintain accuracy in ICD-10-CM coding for all your patients.