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Chapter 8 - Cardiovascular System - ICD-10-CM Coding

Terms in this set (21)

A cerebrovascular accident (CVA) commonly is referred to as a stroke or cerebral infarction. This condition is a result of the lack of blood flow to the brain. The common signs are weakness or paralysis (usually on one side), trouble speaking, change in vision, confusion, severe headache, and problems walking. When the provider documents a stroke or CVA with no additional information, the default code is 163.9 Cerebral infarction, unspecified. Look for Accident/cerebrovascular in the ICD-10-CM Alphabetic Index.
There are sequelae (late effects) that can develop as a result of a CVA. Category 169 is used to indicate conditions classifiable to categories 160-167 as the causes of sequela. The sequela includes neurological deficits that persist after initial onset of the CVA. The neurologic deficits caused by cerebrovascular disease may be present from the onset or may arise at any time after the onset of the condition. Sequela codes that specify hemiplegia, hemiparesis and monoplegia identify whether the dominant or non-dominant side is affected. If not documented, the default is:
- For ambidextrous patients - dominant
- If the left side is affected - non-dominant
- If the right side is affected - dominant
Codes for 160-167 can be reported with sequela codes from category 169 when a patient has a current cerebrovascular disease and residual deficits from an old cerebrovascular disease coexist. Z86.73 Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits is reported for patients with a history of CVA with no neurological deficits present. A TIA is often referred to as a mini stroke. It has the same signs as a CVA, but is not long lasting and does result in permanent damage.
Pay attention to the instructional note Use additional code, found throughout category 169 indicating to rep the condition, syndrome, or sequelae as a secondary code.
An MI, or heart attack, is a sudden decrease in the coronary artery blood flow that results in death of the heart muscle. When an MI is suspected, the provider often orders lab tests to determine the levels of creatinine phosphokinase (CPK) and troponin in the patient's blood. Elevated levels of CPK and troponin may indicate damage to the heart muscle. If there is a diagnosis ; of elevated CPK or elevated troponin, the elevated lab result is coded from Abnormal findings on examination of blood, without diagnosis (R70-R79) in the ICD-10-CM codebook.
When an MI has been diagnosed, it is classified based on the affected heart tissue. The 4'" and 5'h characters describe the location of the infarction (for example, subcategory 121.09 ST elevation myocardial infarction (STEMI) involving other coronary artery of anterior wall.
A subsequent episode of care must be provided within four weeks of the initial episode of care. After four weeks, the MI is considered old. If the patient has a new MI within the four-week period of the initial MI, the second MI is considered to be a subsequent MI, and coded from category 122.
Myocardial infarctions also can be classified by whether there is a ST-segment elevation. STEMI's are coded with subcategories 121.0-121.3, 122.0, 122.1, and 122.8. In this case, the coronary artery is completely blocked, and nearly all the heart muscle being supplied by the affected artery starts to die. The ST refers to the S-T Segment on an electrocardiogram (ECG).
Non ST elevation myocardial infarction (NSTEMI) describes when the blood clot only partly occludes the artery, and only a portion of the heart muscle being supplied by the affected artery dies. This is coded with subcategory 121.4. A subsequent NSTEMI is reported with 122.2.
If during the encounter STEMI is converted to NSTEMI, select a code for STEMI. If NSTEMI evolves to STEMI, select a code for STEMI.
Code selection also identifies the episode of care. The episode options include:
- episode of care unspecified
- initial episode of care
- subsequent episode of care
A code from category 122 Subsequent ST elevation (STEMI) and non-ST elevation (NSTEMI) myocardial infarction is reported when a patient has suffered an AMI and then has a new AMI within four weeks from the initial AMI. A code from category 122 is, to be used with a code from category 121. The sequencing of these codes depends on the circumstances of the encounter.
There is an instructional note under categories 121 and 122 in the Tabular List to Use additional code, if documented, to identify use, exposure or dependence to tobacco, or status post administration of tPA (rtPA).