With the growing issues with high temperatures in many areas of the country and the world for that matter, we see related medical issues occur. Heatstroke and Dehydration are two such issues that arise when the temperatures go up.
Over the past several months we have all heard about, or even experienced high temperatures where we live and work, many have been unexpected occurrences. When the weather brings about high temperatures this can create serious medical concerns. According to the CDC, “Heatstroke”, occurs when the body can no longer control its temperature: the body’s temperature rises rapidly, the sweating mechanism fails, and the body is unable to cool down. When heat stroke occurs, the body temperature can rise to 106°F or higher within 10 to 15 minutes. Heat stroke can cause permanent disability or death if the person does not receive emergency treatment. Some literature state the body temperature of 104°F (40C) or higher can occur with heatstroke.
Common symptoms of Heatstroke include:
- Confusion, altered mental status, slurred speech
- Loss of consciousness (coma)
- Hot, dry skin or profuse sweating
- Very high body temperature
- Fatal if treatment delayed
Similar to Heat Stroke, is “Heat Exhaustion” which is the body’s response to an excessive loss of water and salt, usually through excessive sweating. Heat exhaustion is most likely to affect:
- The elderly
- People with high blood pressure
- Those working in a hot environment
Symptoms of heat exhaustion include:
- Heavy sweating
- Elevated body temperature
- Decreased urine output
In ICD-10-CM alphabetic index under “Heat”, you fill find several terms (here is a partial list):
Heat (effects) T67.9
burn – see also Burn L55.9
dermatitis or eczema L59.8
NOTE: ICD-10-CM has “heatstroke” as one word, some literature has it separated into two words.
Included in the alpha index under Heat is “Stroke” T67.01 and also subcategory
specified NEC T67.09
If you look in the tabular under T67 Effects of heat and light, you will see the instruction to use additional code(s) to identify any associated complications of heatstroke, such as: coma and stupor (R40.-) rhabdomyolysis, systemic inflammatory response syndrome (R65.1-). Then see code T67.0 Heat Stroke and sunstroke listed, followed by “Heat Stroke” T67.01, which has inclusion terminology of:
Heat apoplexy Heat pyrexia Siriasis Thermoplegia
As mentioned in the instruction note under T67.0, another serious medical condition that can occur related to heatstroke is Rhabdomyolysis (rhabdo). This medical condition can be associated with heat stress and prolonged physical exertion as well. Rhabdo causes the rapid breakdown, rupture, and death of muscle. When muscle tissue dies, electrolytes and large proteins are released into the bloodstream. This can develop into irregular heart rhythms, seizures, and damage to the kidneys
Dehydration: Clinically, dehydration occurs when you use or lose more fluid than you take in, and your body doesn’t have enough water and other fluids to carry out its normal functions. If you don’t replace lost fluids, you will get dehydrated. Anyone may become dehydrated, but the condition is especially dangerous for young children and older adults. Dehydration is not always related to an underlying condition. It may be caused by:
- Vomiting & diarrhea (especially in infants, children & elderly) and Decreased water intake
- Heat and Burns
- Drugs that increase urine excretion (diuretics)
- Excessive sweating particularly with prolonged exertion
In ICD-10-CM “Dehydration” in the alphabetic index there are two entries and code possibilities, as follows:
If you go to the tabular for E86 Volume depletion, there is an instructional note, use additional code(s) for any associated disorders of electrolyte and acid-based balance (E87.-). There is also an excludes1 note and an excludes2 note which should be followed. The E86.0 is then listed for the diagnosis/condition of “ Dehydration.”
It’s important for the HIM Coding and CDI professional to review the health record documentation carefully to identify clinical indicators for which a condition or diagnosis has not been stated. If this occurs, they should query the provider (physician) for clarification. In addition, the HIM Coding and CDI professional needs to be aware of the associated conditions that can occur in a patient who has heatstroke and/or dehydration as a diagnosis.
Stay alert to the high-temperature health warnings from the weather experts and follow public health agency guidance that accompanies high temperatures.