Severe winter storms, freezing rain, ice pellets, and heavy snow continue to hit the United States. Physicians’ practices are dealing with a large number of patients with cold injuries and need to know the ICD-10 codes to report these conditions. Medical billing and coding outsourcing is a viable strategy for accurate and timely claim filing for appropriate reimbursement.

Let’s take a look at the ICD-10 codes for common health problems that occur when the temperature dips.

  • Frostbite: Exposure to the cold can cause the top layer of the skin and some of the tissues beneath it to freeze. Common areas affected include ears, nose, cheeks, chin, fingers, and toes. Frostbite occurs in stages: frostnip or first degree frostbite, superficial frostbite or second-degree frostbite, and deep frostbite, the most severe stage that affects both the skin and the underlying tissues. Symptoms of frostbite include skin that looks white, gray or black depending on the severity, skin that feels hard or waxy, blisters, and trouble moving the affected part.The ICD 10 codes for frostbite are:
    • T33 Superficial frostbite
    • T34 Frostbite with tissue necrosis

    The appropriate code to report for these conditions would depend on the anatomic site, including laterality, along with the severity of the frostbite. For e.g:

    • T33.0 Superficial frostbite of head; T33.1 Superficial frostbite of neck; T33.2 Superficial frostbite of thorax; T33.3 Superficial frostbite of abdominal wall, lower back and pelvis, and T33.4 Superficial frostbite of arm T33, etc.
    • T34.0 Frostbite with tissue necrosis of head; T34.1 Frostbite with tissue necrosis of neck; T34.2 Frostbite with tissue necrosis of thorax; T34.3 Frostbite with tissue necrosis of abdominal wall, lower back and pelvis, and T34.4 Frostbite with tissue necrosis of arm, etc.
  • Hypothermia: Hypothermia occurs when the body is unable to replace heat lost due to prolonged exposure to the cold. It develops when the body temperature drops abnormally low body temperature, below 95˚F (35˚C). Symptoms include shivering, slurred speech or mumbling, weak pulse, slow, shallow breathing, lack of coordination, drowsiness, confusion, loss of consciousness, or bright red, cold skin. Hypothermia that is mild (≥33°C [91°F]) is easy to treat. Severe/systemic hypothermia (< 28°C [82.4°F]) is a life-threatening condition with symptoms such as unconsciousness, shallow or no breathing, weak, irregular or no pulse, and dilated pupils, and requires immediate medical attention.
     
    Hypothermia is coded in ICD-10 in category T 68.XXX (A, D, or S).

    • T68 Hypothermia
    • T68.XXXA Hypothermia, initial encounter
    • T68.XXXD Hypothermia, subsequent encounter
    • T68.XXXS Hypothermia, sequela

    An additional code should be used to identify the source of exposure: Excessive cold of manmade origin (W93) or Excessive cold of natural origin (X31). This code would also require the seventh character of A (initial presentation or active treatment), D (subsequent or aftercare of the injury), or S. to report any sequela from the injury.

  • Snow blindness or photokeratitis: Also called arc eye or photokeratitis, snow blindness is the result of excessive exposure to the sun’s ultraviolet (UV) rays. Overexposure to UV light causes the cornea to develop sunburn. In addition to temporary loss of vision, the symptoms of snow blindness include pain in the eyes, headache, and vision blurring. Photokeratitiis is easy to treat, and the eyes will heal quickly with rest and shelter from the UV rays.
     

    The ICD-10 code to specify a diagnosis for snow blindness is H16.13-. Laterality specification (right vs. left) is important when using this code. H16.139 is used if the laterality is unknown. Relevant ICD-10 codes for snow blindness:

    • H16.13 Photokeratitis
    • H16.131 …… right eye
    • H16.132 …… left eye
    • H16.133 …… bilateral
    • H16.139 …… unspecified eye
  • Trench/Immersion Foot: Trench foot is the result of prolonged exposure to cold and wet conditions. Also known as immersion foot syndrome, this non-freezing cold injury (NFCI) affects the skin. The blood vessels constrict to reduce heat loss from the body and lack of oxygen, nutrient loss and toxin buildup causes the skin tissue damage. Trench foot develops within 3-12 hours of exposure, and if severe can affect the toes, heel, or whole foot. The ICD-10 code for trench foot is T69.02. For reimbursement purposes, report the following codes:
    • T69.021 Immersion foot, right foot
    • T69.021A …… initial encounter
    • T69.021D …… subsequent encounter
    • T69.021S …… sequela
    • T69.022 Immersion foot, left foot
    • T69.022A …… initial encounter
    • T69.022D …… subsequent encounter
    • T69.022S …… sequela
    • T69.029 Immersion foot, unspecified foot
    • T69.029A …… initial encounter
    • T69.029D …… subsequent encounter
    • T69.029S …… sequela
  • Chilblains: Also known as pernio, chilblains is a painful inflammation of the small blood vessels in the skin. Though the exact causes are not known, chilblains are believed to be caused by repeated exposure to cold (but not freezing) air. Symptoms include: small, itchy red areas on the skin, typically of the feet or hands, blistering or skin ulcers, swelling, burning sensation and changes in skin color from red to dark blue, along with pain. The ICD-10 code book notes that the condition can be associated with pruritis and a burning feeling.
     
    The ICD-10 code for chilblains is T69.1XX (A, D, or S).

    • T69.1 Chilblains
    • T69.1XXA …… initial encounter
    • T69.1XXD …… subsequent encounter
    • T69.1XXS …… sequel
    • T69.8 Other specified effects of reduced temperature
    • T69.8XXA …… initial encounter
    • T69.8XXD …… subsequent encounter
    • T69.8XXS …… sequela
    • T69.9 Effect of reduced temperature, unspecified
    • T69.9XXA …… initial encounter
    • T69.9XXD …… subsequent encounter
    • T69.9XXS …… sequela

External cause code category X31 should be used to capture exposure to excessive natural cold.

The support of an experienced medical billing service provider can prove very valuable when it comes to ensuring timely and accurate claims submission for optimal reimbursement.