ED Coding and Reimbursement Alert

Question: We have had more patients than usual who have presented for heatstroke, but we aren’t sure which diagnosis code applies to this. The ICD-10 manual refers me to T67.0 (Heatstroke and sunstroke) for this condition, but when we reported this code, we got a denial. Can you advise?

Codify Subscriber

Answer: You were looking at the right section of the ICD-10 manual, but it appears that you submitted a truncated code. T67.0 must be coded out to the seventh character, as noted in the ICD-10 manual. You’ll use the seventh character of “A” for initial encounter, “D” for subsequent encounter, and “S” for sequela.

Typically, in the ED you’ll be seeing patients for an initial encounter, which means the right code would be T67.0XXA. Because there are no characters assigned for the fifth and sixth slots in the code, the two “X” characters fill the space between T67.0 and the “A,” which is the seventh character.