August 4, 2020



For most people, warm summer months mean a trip to the beach, lazy days by the pool, or cooking on a grill in the evening. Spending quality time with your family outdoors can unfortunately also bring certain perils – mosquitoes, ticks, chiggers, and spiders enjoy the summer weather as much as we do. A recent New York Times report states that the number of people getting diseases from insects has more than tripled in the United States. When coding an insect bite, an ‘S’ code is assigned which indicates the location of the bite.  For example:


  • S00.262A Insect bite (nonvenomous) of left eyelid and periocular area, initial encounter
  • S30.860A Insect bite (nonvenomous) of lower back and pelvis, initial encounter
  • S30.861A insect bite of the abdomen, initial encounter
  • S70.362A Insect bite (nonvenomous), left thigh, initial encounter
  • S50.861A Insect bite of right forearm, initial encounter
    Code W57.XXX- (A, D, or S), bitten or stung by nonvenomous insect and other nonvenomous arthropods, is an external cause code used to describe the cause of an injury or other health condition. According to ICD-10 guidelines, no external cause code from Chapter 20 is needed if the external cause and intent are included in a code from another chapter. Since a code for an insect bite would indicate the cause of injury and as intent is not applicable, a code from category W57 does not have to be reported in conjunction with codes for insect bites. A code from category W57 may be reported if an insect bite results in a complication such as a localized infection that requires treatment.

The CDC tells us that about 300,000 Americans get Lyme disease each year, but only 35,000 cases are reported. Wooded areas are home to deer, and deer carry ticks who in turn cause Lyme disease which is a bacterial disease. The symptoms of Lyme disease may involve multiple body systems including the skin, joints, and nervous system. For example:


  • A69.20 Lyme disease unspecified
  • A69.21 Meningitis due to Lyme disease
  • A69.22 Other neurologic disorders in Lyme disease (Cranila neuritis, meningoencephalitis, polyneuropathy)
  • A69.23 Arthritis due to Lyme disease
  • A69.29 Other conditions associated with Lyme disease

Recreational water illnesses (RWIs) are caused by different types of bacteria that can be transmitted through water used for recreational purposes. Swimmers are susceptible to diseases spread through water such as E. coli and Giardia. Contaminated water in swimming pools, hot tubs, water parks, lakes, rivers, and oceans can expose recreational water enthusiasts to these diseases. For example:


  • E.coli is a type of bacteria present in the intestines of people and animals. While most strains of E.coli are not harmful, some types can cause illness such as diarrhea, abdominal pain, fever, and sometimes vomiting. Severe infection can cause bloody diarrhea, dehydration, or even kidney failure. The ICD-10 code for E.coli is B96.20, Unspecified Escherichia coli [E. coli] as the cause of diseases classified elsewhere
  • Giardia, another intestinal infection, causes abdominal cramps, bloating, nausea and bouts of watery diarrhea. Though the infections usually resolve in a few weeks, intestinal problems may persist, even after the parasites are gone. The ICD-10 code for Giardia is A07.1, Giardiasis [lambliasis].
  • Norovirus is a major cause of acute gastroenteritis and can lead to the sudden onset of severe vomiting and diarrhea. This highly contagious virus is commonly spread through contaminated food or water or close contact with an infected person. It can cause diarrhea, abdominal pain and vomiting 12 to 48 hours after exposure. Norovirus is classified to ICD-10 code A08.1, Acute gastroenteropathy due to Norwalk agent.
  • Cryptosporidiosis or Crypto is caused by cryptosporidium, a microscopic parasite that causes a diarrheal disease. Other symptoms include stomach cramps or pain, dehydration, nausea, vomiting, fever, and weight loss. On the other hand, some people with Crypto will have no symptoms at all. Those with weakened immune systems may develop serious, chronic, and sometimes fatal illness. The ICD-10 code is A07.2, Cryptosporidiosis

Poison oak, ivy and sumac are present on hiking trails or around campsites. Contact with these plants can cause redness, itching, swelling, and blisters. The rash usually appears 8 to 48 hours after contact. Even inhaling the smoke from a burning plant can cause a reaction which includes breathing difficulties. For example:


  • L23.7 Allergic contact dermatitis due to plants, except food

Damage to the skin as a result of overexposure to the natural sun (sunburn) can cause redness, swelling, blisters, pain, and flu-like symptoms. ICD-10 coding of sunburns allows complete coding based on the severity of the burn. For example:


  • L55.0, sunburn first-degree sunburn
  • L55.1, sunburn of second degree
  • L55.2, sunburn of third degree
  • L55.9, sunburn unspecified


This list of ailments associated with working and playing outdoors is not exhaustive and includes only the most common. To help you stay healthy, it is important to take preventative measures when outdoors such as wearing light-colored, loose cotton clothing, using a higher SPF sunscreen, and avoiding exposure to direct sunlight during peak sun hours.





Cynthia Alder-Smith, RHIT CCS

Auditor, Educator Excite Health Partner