Are you prepared for the solar eclipse...injury coding?

Are you ready for Monday’s solar eclipse? Are you in the path of totality? What time does it start in your area? Do you have your solar viewing glasses? What is the ICD-10-CM code for photokeratitis? Wait, what was that last one? 

It’s difficult to look at the news or social media without seeing mention of the solar eclipse. I bought a new keyboard from an online vendor a couple of months ago and immediately started getting sales emails for solar viewing glasses. Wow. We didn’t have those when I was in elementary school.  We watched the eclipse through a pinhole in a piece of paper.  How many times did the teacher tell us not to look directly at the sun? That’s right, a lot, and it made an impression. Now we can buy solar viewing glasses. Technology is amazing.

I’ve been reading a lot of news and online articles about the solar eclipse since receiving that sales email about solar viewing glasses.  I didn’t realize it until then, but a city where I used to live (Clayton, Georgia) is in the path of totality. That was where I started my coding career in the Medical Records department of Rabun County Memorial Hospital.  I wish I still had the house up there with the big wrap around porch and deck. That would have been a nice setting for an eclipse viewing party!

An article from Quartz on the eclipse caught my eye because it didn’t just refer to the mechanics of what happens with the sun and the moon, but actually described the injuries a person could inflict upon themselves by looking directly at the sun. It included clinical diagnostic terminology. I thought about all of the Emergency Department visits I coded in my time at RCMH. People coming to the Northeast Georgia Mountains on vacation and leaving with stitches or in a cast with crutches. Will that happen with the eclipse and eye injuries? Will people flock to Clayton and think their designer sunglasses are good enough to safely watch the eclipse? What if someone believes they have reputable solar viewing glasses and come to find out, after the injury occurs, that the product was recalled? It is safe to look at the eclipse once it is total, but how many people are going to misjudge the time and look when it is still partial and injure their eyes? The light bulb went off. What are the ICD-10-CM diagnosis codes for those injuries? 

Let’s get the legalese out of the way first. With the understanding that this is coding advice and assignment of actual codes is dependent upon the medical record documentation and is the responsibility of the coder, here are some specific codes to make note of in case a patient arrives with ophthalmologic injuries caused by the solar eclipse. 

First, let’s look at Photokeratitis, which is like a sunburn of the cornea from ultraviolet exposure. If you have ever had a scratched cornea, think about how uncomfortable this would be. Why don’t we normally stare at the sun? Correct, because it’s too bright, and it hurts our eyes. It’s a nice defense mechanism to keep us from doing something that is bad for us.  When the sun is dimmed during an eclipse, it can be tempting to look directly at it, but the ultraviolet light is still there and burns the cornea. Photokeratitis is also known as snow blindness or welder's keratitis. If a new welder forgets to put on their helmet before using the welding torch, they get the same injury, and coders may have assigned the below. 

Photokeratitis Section                                                H16.13 (incomplete code)

Photokeratitis, right eye                                             H16.131
Photokeratitis, left eye                                               H16.132
Photokeratitis, bilateral                                              H16.133
Photokeratitis, unspecified eye                                H16.139

Next, there is Solar Retinopathy. I searched for the word “eclipse” in the Integrated Codebook and found a scary entry under Blindness for Eclipse Blindness (total) and was instructed to see Retinopathy, solar. Solar Retinopathy is a burn of the retina from the ultraviolet exposure. 

Solar retinopathy Section                                           H31.02 (incomplete code)

Solar retinopathy, right eye                                        H31.021
Solar retinopathy, left eye                                          H31.022
Solar retinopathy, bilateral                                         H31.023
Solar retinopathy, unspecified eye                           H31.029

And finally, we can’t forget about the external cause codes. I was a bit surprised when I looked this up. Because of all the past discussion about the many different external cause codes in ICD-10, I was expecting more specificity in this area, but as you can see, it is just the one code.    

External Cause
Exposure to sunlight Section                                          X32 (incomplete code)

Exposure to sunlight, initial encounter                          X32XXXA
Exposure to sunlight, subsequent encounter               X32XXXD
Exposure to sunlight, sequela                                         X32XXXS

Then, add the place of occurrence and activity codes if applicable to your area or coding guidelines.

Under this section, there is an excludes note for man-made visible and ultraviolet light like welding light and tanning beds, but when it comes to the sun, it’s all included in the one code. This explains why the Quartz article mentioned that there isn’t much data on eclipse-related eye injuries. Without an eclipse-specific code, how can we determine the number of ophthalmic injuries due to improper viewing? We have time to request new external cause codes before the next U.S. total solar eclipse in the year 2024.

Remember, these injuries can occur in any area where the eclipse can be seen, either total or partial, if the viewer looks at the sun during the eclipse when it is not completely total. In Clayton, the eclipse begins at 1:06:59 and doesn’t end until 4:01:27, and will only be total between 2:35:49 and 2:38:23, so synchronize your watches.

Let’s all hope there aren’t any Emergency Department visits related to the eclipse, but if there are, you’ve had your introduction to the related diagnosis codes.

Happy coding!

Lisa Lanier is a methodology consultant for Grouper Based Service Offerings with the Population and Payment Solutions group for 3M Health Information Systems.

References:  Rubin, M. (2017, August 4). Once in a Blue Moon: Total eclipse of the sun: A complete guide to the 2017 solar eclipse.  Quartz,. Retrieved from https://qz.com/1045574/how-to-watch-the-2017-solar-eclipse-a-complete-guide-to-when-where-and-how-to-watch-safely/