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Chapter 8 - Cardiovascular System - ICD-10-CM Coding
Terms in this set (21)
An arrhythmia (dysrhythmia) is an abnormal heart rate or rhythm. Common types include: premature atrial contractions (PACs), premature ventricular contractions (PVCs), atrial fibrillation (AF), atrial flutter, paroxysmal supraventricular tachycardia (PSVT), ventricular tachycardia (V-tach), ventricular fibrillation (V-fib), and bradycardia. Some arrhythmias arise from conduction disorders; abnormal electrical impulses in the heart. Common conduction disorders include atrioventricular block, right and left bundle branch block (BBB), and Long Q-T Syndrome. Most ICD-10-CM codes for arrhythmias and conduction disorders are found in category I49 and subcategory P03-81 when related to pregnancy. There are separate codes for psychogenic arrhythmia (F45.8) and vagal arrhythmia (R55).
Hypertension (HTN), or high blood pressure, is classified as either primary (essential) or secondary. About 90-95 percent of cases are termed primary hypertension, for which no medical cause can be found. The remaining 5-10 percent of cases (secondary hypertension) are caused by other conditions affecting the kidneys, arteries, heart or endocrine system. The Official ICD-10-CM guideline I.C.7.a.2 gives extensive direction on code assignment. Hypertension is assigned to categories I10-I15.
Hypertension with Heart Disease
Hypertension with heart disease presumes a casual relationship between the heart disease and hypertension as the conditions are linked by the term "with" in the Alphabetic Index. Hypertension and heart disease ore coded as related even when documentation does not specifically link the conditions. Report also an additional code from category I50 to identify the type of heart failure, if present. More than one code from category I50 may be assigned if necessary to describe fully the patient's condition. If the physician's documentation specifies a different cause, the conditions are reported separately.
Hypertensive Chronic Kidney Disease
Hypertension and chronic kidney disease (CKD) has a presumed causal relationship. When conditions classifiable to N18 Chronic kidney disease are present, assign codes from category I12 Hypertensive chronic kidney disease. Use an additional code to identify the stage of CKD from category N18.
Hypertensive Heart and Chronic Kidney Disease
When a patient has both hypertensive heart disease and CKD, assign a code from category I13 Hypertensive heart and chronic kidney disease. ICD-10-CM guidelines specify an assumed relationship between the conditions. An additional code or codes is assigned from category I50 Heart failure to indicate the type of heart failure. As additional code from category N18 is necessary to identify the stage of kidney disease.
Hypertensive Cerebrovascular Disease
When a patient has hypertensive cerebrovascular disease (I60-I69), code that condition first. List second the appropriate hypertension code.
Two codes are necessary to identify this condition. Assign first the code H35.0 Background retinopathy and retinal vascular changes, followed by the appropriate code from categories I10-I15 to show the type of hypertension.
Two codes are required to report secondary hypertension. Assign one code to show the underlying etiology and another code from category I15 to identify the type of hypertension. Sequencing order is determined by the reason for the admission or encounter.
Transient Hypertension and Elevated Blood Pressure
Assign R03.0 Elevated blood pressure reading without diagnosis of hypertension, unless the patient has an established diagnosis of hypertension. For transient hypertension complicating pregnancy, assign a code from category O14. Gestational hypertension without significant proteinuria is reported with a code from category O13.
Hypertension, Controlled or Uncontrolled
Controlled hypertension usually refers to an existing state of hypertension under control by therapy. Uncontrolled hypertension may refer to untreated hypertension or hypertension not responding to therapy. Assign the appropriate code from categories I10-I15.
Assign a code from category I16, Hypertensive crisis, for documented hypertensive urgency, hypertensive emergency or unspecified hypertensive crisis. Code also any identified hypertensive disease (I10-I15). The sequencing is based on the reason for the encounter.
Arteriosclerosis is hardening of the arteries. If it is arteriosclerosis of the coronary arteries, assign a code from category I25 Chronic ischemic heart disease. Code selection indicates whether the atherosclerosis is of native artery, bypassed artery, or transplanted heart. Angina pectoris is characterized by chest pain and is common in patients with arteriosclerosis. When both conditions are documented, a causal relationship is assumed between arteriosclerosis and angina pectoris unless it is specifically stated the angina is due to another cause. Combination codes are used to report arteriosclerosis with angina pectoris (I25.11, I25.7). When the combination codes are reported, angina pectoris is not reported with an additional code as it is included in the combination code.
Endocarditis is inflammation or infection of the inner lining of the heart (endocardium). Left untreated, it can damage or destroy the heart valves. Bacterial infection is the most common source, but the cause may be fungi or unidentified. Most codes for endocarditis are found in the categories I33-I39. Rheumatic endocarditis is an exception: Acute rheumatic endocarditis is coded as I01.1 and chronic rheumatic endocarditis is I09.1.
Sometimes multiple codes are necessary to report acute endocarditis when the infectious organism is know or when the underlying disease is known. The order will depend on the type of endocarditis. For example, acute streptococcal endocarditis is coded I33.0, B95.-.
Pericarditis is inflammation of the sac surrounding the heart (pericardium) caused by infection. Most codes for pericarditis are found in categories I30-I32. Multiple codes may be necessary to describe the patient condition if the underlying disease is documented. Observe ICD-10-CM guidelines for sequencing.
Heart Failure (congestive heart failure) occurs when the heart cannot pump enough blood to supply the body's other organs. Multiple codes may be necessary to describe the condition or combination codes may be used. For example, hypertensive heart failure (explained above) requires at least two codes. In contrast, acute systolic and diastolic heart failure are reported with combination code I50.41.
Peripheral Arterial Disease (PAD)
PAD affects the arteries outside the heart and brain. It is the most common type of peripheral vascular disease (PVD). If the only diagnosis given is PAD or PVD, report unspecified code I73.9. If the PVD is due to diabetes, report E08-E13 with .51-.52 depending on the presence of gangrene.
The most prominent heart valve disorders are stenosis, regurgitation and prolapse. Valve stenosis occurs when one or more of the heart valve openings narrows and restricts blood flow through the heart. Valve regurgitation occurs when the valve does not close properly. Valve prolapse occurs when valve leaflets prolapse into the heart chamber. Code selection is driven by which valve(s) is affected and whether the condition is congenital or acquired. For congenital heart valve stenosis, look to categories Q22 and Q23. For non-congenital disorders, you must know if the condition is rheumatic, acute, or involves multiple valves.
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.
Myocardial Infarction (MI)
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).
Intraoperative and Postprocedural Complications
Codes from category code 197 Intraoperative and post-procedural complications and disorders of circulatory system, not elsewhere classified (NEC) are reported when there is a complication(s) of the circulatory system during or after a surgery specific procedure. These codes identify a complication that is diagnosis specific (for example, 197.81 Intraoperative cerebrovascular infarction). The 45h and 5511 characters in this code category (with the exception of codes that end with .8, .88, or .89) indicates the type of complication. A 6th character indicates if the complication was due to a cardiac surgery/ procedure or other type of surgery/procedure. Documentation should indicate the condition (for example, hematoma) and the procedure (for example, cardiac catheterization) for proper code assignment.
Anticoagulant therapy is when a certain type of medication (for example, Coumadin) is used to prevent clot formations within a blood vessel. This type of therapy is used for different types of vascular disorders such as, atrial fibrillation, pulmonary embolism or venous thrombosis.
When the medical record documents a vascular disorder as a final diagnosis and documents that the patient is currently taking or has a long-term use of an anticoagulant medication, report code Z79.01 as an additional diagnosis. This Z code is found in the ICD-10-CM Alphabetic Index by looking for Long-term (current) (prophylactic) drug therapy (use of)/anticoagulants.
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