Cardiology ICD-10 CM Training. ICD-10-CM will be valid for dates of service on or after October 1,...

Cardiology

ICD-10 CM Training

• ICD-10-CM will be valid for dates of service on or after October 1, 2015– Outpatient dates of service of October 1, 2015 and

beyond. – Inpatient hospital service claims, is effective for dates of

discharge after September 30, 2015

ICD-10-CM Compliance Dates

• Covered Entities– Everyone covered by the Health Insurance Portability

Accountability Act (HIPPA)

• Non-Covered Entities– Worker’s Compensation– Auto Insurance– Non covered HIPAA entities are exempt but are

encouraged to adapt the new code set

Covered and Non-Covered Entities

• 21 Chapters• Alpha-numeric codes; not case-sensitive

– Codes begin with Alpha letter, A-Z, excluding U– Common errors

• I verses 1• O verses 0

• “X” Placeholder• 3 to 7 characters

– Decimal following 3rd character

ICD-10 Code Structure

• Placeholder “X”– Used for future expansion of a code– Fills in empty characters when a 6th and/or 7th character

apply– The placeholder may be used in different scenarios but

should never serve as the final character.

Example: W19.XXXA Unspecified fall, Initial Encounter


• 7th Character– Provides specified information regarding the clinical visit– Is required for certain categories and must be reported in

the seventh position– May be alpha or numeric– Has different meanings depending on the coding category


• Laterality– Some ICD-10-CM codes indicate laterality, specifying

whether the condition occurs on the left, right or is bilateral.

– If no bilateral code is provided and the condition is bilateral, assign separate codes for both the left and right side.

– If the side is not identified in the medical record, assign the code for the unspecified side.

OGCR section 1.B.13


• “Other” Codes– Codes titled “other” or “other specified” are for use when

the information in the medical record provides detail for which a specific code does not exist.

• “Unspecified” Codes– Codes titled “unspecified” are for use when the

information in the medical record is insufficient to assign a more specific code.

OGCR section 1.A.9.a.b


• Excludes Notes– Excludes1

• A type 1 Excludes note is a pure excludes note• It means “NOT CODED HERE”• The code excluded should never be used at the same time• When two conditions cannot occur together

– Excludes2• Represents “Not included here”• The condition excluded is not part of the condition represented

by the code• It is acceptable to use both the code and the excluded code

together, when appropriateOGCR section 1.A.12.a.b

ICD-10 Structure

• “Code First” and “Use Additional Code”– ICD-10 has a coding convention that requires the

underlying condition be sequenced first followed by the manifestation.

– These instructional notes indicate the proper sequencing order of the codes.

OGCR section 1.A.13

• The “-” indicates there are additional reporting options


Most Common Diagnosis Codes

Chest painICD-9 Code ICD-10 Code Description Excludes1 Excludes2

786.50 R07.9 Chest pain, unspecified • epidemic myalgia (B33.0)

• jaw pain R68.84• pain in breast (N64.4)

There are more specific code choice selections:

786.51 R07.2 Precordial pain

786.52 R07.1 Chest pain on breathing

786.52 R07.81 Pleurodynia

786.59 R07.82 Intercostal pain

786.59 R07.89 Other chest pain

• Type– Chest pain due to myocardial ischemia– Chest pain on breathing– Intercostal pain– Pleurodynia– Precordial chest pain

Use of a symptom code with a definitive diagnosis codeCodes for signs and symptoms may be reported in addition to a related definitive diagnosis when the sign or symptom is not routinely associated with that diagnosis, such as the various signs and symptoms associated with complex syndromes. The definitive diagnosis code should be sequenced before the symptom code.

Signs or symptoms that are associated routinely with a disease process should not be assigned as additional codes, unless otherwise instructed by the classification.OGCR Section I.C.18.b

Documentation Tips

Atherosclerotic heart disease of native coronary artery without angina pectorisICD-9 Code ICD-10 Code Description Excludes1 Excludes2

414.00 I25.10 Atherosclerotic heart disease of native coronary artery without angina pectoris

Applicable To:• Atherosclerotic heart

disease NOS

N/A • atheroembolism (I75.-)• atherosclerosis of coronary artery

bypass graft(s) and transplanted heart (I25.7-)414.01 I25.10

No ICD-10 code exists for unspecified vessel; native or bypass graft must be indicated

Use additional code, if applicable, to identify:• coronary atherosclerosis due to calcified coronary lesion (I25.84)• coronary atherosclerosis due to lipid rich plaque (I25.83)

• chronic total occlusion of coronary artery (I25.82)• exposure to environmental tobacco smoke (Z77.22)• history of tobacco use (Z87.891)• occupational exposure to environmental tobacco smoke (Z57.31)• tobacco dependence (F17.-)• tobacco use (Z72.0)

• Associated Artery/Lesion Type– Native artery– Bypass graft– Bypass graft, autologous artery– Bypass graft, autologous vein– Bypass graft, nonautologous biological– Bypass graft, other– Due to calcified coronary lesion– Due to lipid rich plaque

• Native vs Transplanted Heart• Associated angina

– Without angina– With unstable angina– With angina and spasm

Artherosclerotic Heart DiseaseCoronary Artery Documentation Tips

Atrial fibrillationICD-9 Code ICD-10 Code Description Excludes1 Excludes2

427.31 I48.91 Unspecified atrial fibrillation

N/A N/A

There are more specific code choice selections available below:

I48.0 Paroxysmal atrial fibrillation

I48.1 Persistent atrial fibrillation

I48.2 Chronic atrial fibrillationPermanent atrial fibrillation

• Type– Chronic (I48.2)– Paroxysmal (I48.0)– Persistent (I48.1)

Atrial Fibrillation Documentation Tips

Cardiac ArrhythmiasICD-9 Code ICD-10 Code Description Excludes1 Excludes2

427.89 I49.8 Other specified cardiac arrhythmias

Applicable To:• Coronary sinus rhythm

disorder• Ectopic rhythm disorder• Nodal rhythm disorder

• bradycardia NOS (R00.1)• neonatal dysrhythmia

(P29.1-)• sinoatrial bradycardia (R00.1)• sinus bradycardia (R00.1)• vagal bradycardia (R00.1)

N/A

427.89 R00.1 Bradycardia, unspecified

Applicable To:• Sinoatrial bradycardia• Sinus bradycardia• Slow heart beat• Vagal bradycardia

• abnormalities originating in the perinatal period (P29.1-)

• specified arrhythmias (I47-I49)

• neonatal bradycardia (P29.12)

N/A

There are more code choice selections below:

427.9 I49.9 Cardiac arrhythmia, unspecified

• Type– Atrial fibrillation– Atrial flutter– Premature depolarization– Re-entry ventricular arrhythmia– Sick sinus syndrome– Supraventricular tachycardia– Ventricular fibrillation– Ventricular flutter– Ventricular tachycardia– Paroxysmal tachycardia– Cardiac arrhythmia

Cardiac Arrhythmias Documentation Tips

• Fibrillation Type– Chronic– Paroxysmal– Persistent

• Flutter Type– Typical– Atypical

• Premature Depolarization Type– Atrial– Junctional– Ventricular


• R00.1 - Use Additional code for adverse effect, if applicable, to identify drug (T36-T50 with fifth or sixth character 5)

• I49 - Code first cardiac arrhythmia complicating:– Abortion or ectopic or molar pregnancy (O00-O07, O08.8)– Obstetric surgery and procedures (O75.4)


Abnormal electrocardiogram [ECG] [EKG]ICD-9 Code ICD-10 Code Description Excludes1 Excludes2

794.31 R94.31 Abnormal electrocardiogram [ECG] [EKG]

• long QT syndrome (I45.81)

• abnormal findings on antenatal screening of mother (O28. -)

• abnormal findings on antenatal screening of mother (O28.-)

• certain conditions originating in the perinatal period (P04-P96)

• signs and symptoms classified in the body system chapters

• signs and symptoms of breast (N63, N64.5)

• Symptom Codes – Codes that describe symptoms and signs are acceptable for reporting

purposes when a related definitive diagnosis has not been established (confirmed) by the provider.

• Use of a symptom code with a definitive diagnosis code– Codes for signs and symptoms may be reported in addition to a

related definitive diagnosis when the sign or symptom is not routinely associated with that diagnosis code.

• Signs or symptoms that are associated routinely with a disease process should not be assigned as additional codes, unless otherwise instructed by the classification.

Documentation Tips

Aortic Valve Disorders NonrheumaticICD-9 Code ICD-10 Code Description Excludes1 Excludes2

424.1 I35.0 Nonrheumatic aortic (valve) stenosis

• Aortic valve disorder of unspecified cause but with diseases of mitral and/or tricuspid valve(s) (I08.-)

• Aortic valve disorder specified as congential (Q23.0, Q23.1)

• Aortic valve disorder specified as rheumatic (I06.-)• Hypertrophic subaortic stenosis (I42.1)

N/A

There are more specific code choice selections below:

424.1 I35.1 Nonrheumatic aortic (valve) insufficiency

424.1 I35.2 Nonrheumatic aortic (valve) stenosis with insufficiency

424.1 I35.8 Other nonrheumatic aortic valve disorders

424.1 I35.9 Nonrheumatic aortic valve disorder, unspecified

• Type– Stenosis– Insufficiency– Stenosis with insufficiency– List other

Documentation Tips

Shortness of breathICD-9 Code ICD-10 Code Description Excludes1 Excludes2

786.05 R06.02 Shortness of breath • abnormalities originating in the perinatal period (P29.1-)

• specified arrhythmias (I47-I49)• acute respiratory distress

syndrome (J80)• respiratory arrest (R09.2)• respiratory arrest of newborn

(P28.81)• respiratory distress syndrome

of newborn (P22.-)• respiratory failure (J96.-)• respiratory failure of newborn

(P28.5)• tachypnea NOS (R06.82)• transient tachypnea of

newborn (P22.1)

N/A


786.09 R06.00 Dyspnea, unspecified

786.02 R06.01 Orthopnea

786.09 R06.09 Other forms of dyspnea

• Dyspnea Type– Shortness of breath– Orthopnea– Other forms

Documentation Tips

Ventricular premature depolarizationICD-9 Code ICD-10 Code Description Excludes1 Excludes2

427.69 I49.3 Ventricular premature depolarization

• bradycardia NOS (R00.1)• neonatal dyrhythmia

(P29.1-)• sinoatrial bradycaria

(R00.1)• sinus bradycaria (R00.1)• vagal bradycaria (R00.1)

N/A


427.69 I49.49 Other premature depolarization

Code first cardiac arrhythmia complicating:• Abortion or ectopic or molar pregnancy (O00.-O07, O08.8)• Obstetric surgery and procedures (O75.4)

• Type– Atrial premature depolarization (I49.1)– Junctional premature depolarization (I49.2)– Ventricular premature depolarization (I49.3)– Other specified cardiac arrhythmias (I49.8)

Documentation Tips

Ventricular tachycardiaICD-9 Code ICD-10 Code Description Excludes1 Excludes2

427.1 I47.2 Ventricular tachycardia • tachycardia NOS (R00.0)

• Sinoatrial tachycaria (R00.0)

• sinus tachycardia (R00.0)

Code first cardiac arrhythmia complicating:• Abortion or ectopic or molar pregnancy (O00.-O07, O08.8)• Obstetric surgery and procedures (O75.4)

Other cardiomyopathiesICD-9 Code ICD-10 Code Description Excludes1 Excludes2

425.4 I42.8 Primary cardiomyopathies, NEC

• Ischemic cardiomyopathy (I25.5)

• Peripartum cardiomyopathy (O90.3)

• Ventricular hypertrophy (I51.7)


425.4 I42.2 Other hypertrophic cardiomyopathy

425.4 I42.5 Other restrictive cardiomyopathy

425.4 I42.9 Cardiomyopathy, unspecified (familial)(idiopathic)

Code first pre-existing cardiomyopathy complicating pregnancy and puerperium (O99.4)

Syncope and collapseICD-9 Code ICD-10 Code Description Excludes1 Excludes2

780.2 R55 Syncope and collapse

Applicable To:• Blackout• Fainting• Vasovagal attack

• cardiogenic shock (R57.0)• carotid sinus syncope

(G90.01)• heat syncope (T67.1)• neurocirculatory asthenia

(F45.8)• neurogenic orthostatic

hypotension (G90.3)• orthostatic hypotension

(I95.1)• postprocedural shock

(T81.1-)• psychogenic syncope

(F48.8)• shock NOS (R57.9)• shock complicating or

following abortion or ectopic or molar pregnancy (O00-O07, O08.3)

• shock complicating or following labor and delivery (O75.1)

• Stokes-Adams attack (I45.9)• unconsciousness NOS

(R40.2-)

• abnormal findings on antenatal screening of mother (O28.-)

• certain conditions originating in the perinatal period (P04-P96)

• signs and symptoms classified in the body system chapters

• signs and symptoms of breast (N63, N64.5)

• Type– Carotid sinus syncope (G90.01)– Heat syncope

• Initial encounter (T67.1XXA)• Subsequent encounter (T67.1XXD)• Sequela (T67.1XXS)

– Psychogenic syncope (F48.8)– Stokes-Adams syncope (I45.9)– Vasovagal syncope (R55)

Documentation Tips

CardiomegalyICD-9 Code ICD-10 Code Description Excludes1 Excludes2

429.3 I51.7 Cardiomegaly

Applicable To:• Cardiac dilatation• Cardiac hypertrophy• Ventricular dilatation

N/A • certain conditions originating in the perinatal period (P04-P96)

• certain infectious and parasitic diseases (A00-B99)

• complications of pregnancy, childbirth and the puerperium (O00-O9A)

• congenital malformations, deformations, and chromosomal abnormalities (Q00-Q99)

• endocrine, nutritional and metabolic diseases (E00-E88)

• injury, poisoning and certain other consequences of external causes (S00-T88)

• neoplasms (C00-D49)• symptoms, signs and abnormal

clinical and laboratory findings, not elsewhere classified (R00-R94)

• systemic connective tissue disorders (M30-M36)

• transient cerebral ischemic attacks and related syndromes (G45.-)

HypertensionICD-9 Code ICD-10 Code Description Excludes1 Excludes2

401.1401.9401.0

I10 Essential (Primary) HypertensionIncludes: high blood pressure, Hypertension (arterial) (benign) (essential) (malignant) (systemic)

• Hypertensive disease complicating pregnancy, childbirth and the puerperium (O10-O11, O13-O16)

• Neonatal hypertension (P29.2)

• Primary pulmonary hypertension (I127.0)

• Essential (primary) hypertension involving vessels of brain (I60-I69)

• Essential (primary) hypertension involving vessels of eye (H35.0-)

Hypertensive Diseases Categories (I10-I15)

The use additional codes and Excludes1 codes apply for all categories.

(I10-I15) Use additional code to identify:• Exposure to

environmental tobacco smoke (Z77.22)

• History of tobacco use (Z87.891)

• Occupational exposure to environmental tobacco smoke (Z57.31)

• Tobacco dependence (F17.-)

• Tobacco use (Z72.0)

• Hypertensive disease complicating pregnancy, childbirth and the puerperium (O10-O11. O13-O16)

• Neonatal hypertension (P29.2)

• Primary Pulmonary hypertension (I27.0)

Hypertension cont.

ICD-9 Code ICD-10 Code Description Excludes1 Excludes2

402.01402.11402.91

I11.0 Hypertensive Heart Disease with heart failure• Use additional code to

identify type of heart failure (I50.-)

N/A N/A

402.00402.10402.90

I11.9 Hypertensive Heart Disease without heart failure

N/A N/A

403.01403.11403.91

I12.0 Hypertensive Chronic Kidney Disease with stage 5 Chronic Kidney Disease or end stage renal disease.• Use additional code to

identify the stage of chronic kidney disease (N185.5, N18.6)

• Hypertension due to Kidney Disease (I15.0, I15.1)

• Renovascular Hypertension (I15.0)

• Secondary Hypertension (I115.-)

Acute Kidney Failure (N17.-)

403.00403.10403.90

I12.9 Hypertensive Chronic Kidney Disease with stage 1-4 Chronic Kidney Disease, or unspecified Chronic Kidney Disease.• Use additional code to

identify the stage of chronic kidney disease (N18.1-N18.9)

• Hypertension due to Kidney Disease (I15.0, I15.1)

• Renovascular Hypertension (I15.0)

• Secondary Hypertension (I115.-)

Acute Kidney Failure (N17.-)

Hypertension cont.ICD-9 Code ICD-10 Code Description Excludes1 Excludes2

404.01404.11404.91

I13.0 Hypertensive heart and chronic kidney disease with heart failure and stage 1-4 chronic kidney disease, or unspecified chronic kidney disease• Use additional code to identify

type of heart failure (I50.-)• Use additional code to identify

stage of chronic kidney disease (N18.1-NN18.4, N18.9)

N/A N/A

404.00404.10404.90

I13.10 Hypertensive Heart and Chronic Kidney Disease without heart failure, with stage 1-4 chronic kidney disease, or unspecified chronic kidney disease.• Use additional code to identify

the stage of chronic kidney disease (N18.1-N18.4, N18.9)

N/A N/A

404.02404.12404.92

I13.11 Hypertensive heart and chronic kidney disease without heart failure, with stage 5 chronic kidney disease or end stage renal disease.• Use additional code to identify

the stage of chronic kidney disease (N18.5, N18.6)

N/A N/A

404.03404.13404.93

I13.2 Hypertensive heart and chronic kidney disease with heart failure and with stage 5 chronic kidney disease, or end stage renal disease.• Use additional code to identify

type of heart failure (I50.-)• Use additional code to identify

the stage of chronic kidney disease (N18.5. N18.6)

N/A N/A

Hypertension cont.ICD-9 Code ICD-10 Code Description Excludes1 Excludes2

405.01405.11405.91

I15.0 Renovascular Hypertension• Code also underlying

condition

Postprocedural hypertension (I97.3)

• Secondary hypertension involving vessels of brain (I60-I69)

• Secondary hypertension involving vessels of eye (H35.0-)

405.91 I15.1 Hypertension secondary to other renal disorders• Code also underlying

condition




405.99 I15.2 Hypertension secondary to endocrine disorders• Code also underlying

condition




405.09405.19405.99

I15.8 Other secondary hypertension• Code also underlying

condition




405.99 I15.9 Secondary hypertension, unspecified• Code also underlying

condition




• Hypertension is no longer classified as benign, malignant or unspecified.• ICD-10 Codes have been grouped according to disease progression:

– I10 Essential Hypertension– I11.- Hypertensive Heart Disease– I12.- Hypertensive CKD

» Further subdivided by stage of kidney disease

– I13.- Hypertensive Heart and CKD» Further subdivided by stage of kidney disease

– I15.- Secondary Hypertension

• Transient Hypertension– A code for hypertension is NOT assigned unless the patient has a

documented, established diagnosis of hypertension.• R03.0 Elevated blood pressure reading without diagnosis of hypertension

• Document requirements– Type– Current Status– Associated relationships

Hypertension Documentation Tips

HyperlipidemiaICD-9 Code ICD-10 Code Description Excludes1 Excludes2

272.4 E78.4 Other Hyperlipidemia• Familial

combined hyperlipidemia

• Sphingolipidosis (E75.0-E75.3)

N/A

272.4 E78.5 Hyperlipidemia, unspecified

There are more specific code choice selections available below:

272.0 E78.0 Pure Hypercholesterolemia

272.1 E78.1 Pure Hypercholesterolemia

272.2 E78.2 Mixed Hyperlipidemia

272.3 E78.3 Hyperchylomicronemia

272.5 E78.6 Lipoprotein deficiency

• Type– Mixed– Other– Unspecified

Hyperlipidemia Documentation Tips

Heart failure, unspecifiedICD-9 Code ICD-10 Code Description Excludes1 Excludes2

428.0 I50.9 Heart failure, unspecified

Applicable To:• Biventricular (heart) failure NOS• Cardiac, heart or myocardial

failure NOS• Congestive heart disease• Congestive heart failure NOS• Right ventricular failure

(secondary to left heart failure)

• Cardia arrest (I46.-)

• Neonatal cardiac failure (P29.0)

• fluid overload (E87.70)

N/A

Code first:• Heart failure complicating abortion or ectopic or molar pregnancy (O00-O07, O08.8)• Heart failure following surgery (I97.13-)• Heart failure due to hypertension (I11.0)• Heart failure due to hypertension with chronic kidney disease (I13.-)• Obstetrics surgery and procedures (O75.4)• Rheumatic heart failure (I09.81)

• Type– Systolic– Diastolic– Combined

• Chronicity– Acute– Chronic– Acute on chronic

Heart failure, unspecified Documentation Tips

1) Hypertension with Heart Disease Heart conditions classified to I50.- or I51.4-I51.9, are assigned to a code from category I11, Hypertensive heart disease, when a causal relationship is stated (due to hypertension) or implied (hypertensive). Use an additional code from category I50, Heart failure, to identify the type of heart failure in those patients with heart failure.


2) Hypertensive Chronic Kidney Disease Assign codes from category I12, Hypertensive chronic kidney disease, when both hypertension and a condition classifiable to category N18, Chronic kidney disease (CKD), are present. Unlike hypertension with heart disease, ICD-10-CM presumes a cause-and-effect relationship and classifies chronic kidney disease with hypertension as hypertensive chronic kidney disease. The appropriate code from category N18 should be used as a secondary code with a code from category I12 to identify the stage of chronic kidney disease. See Section I.C.14. Chronic kidney disease. If a patient has hypertensive chronic kidney disease and acute renal failure, an additional code for the acute renal failure is required.


On October 01, 2015 we will monitor claims for date of service rules

• Outpatient claims cannot have crossover dates • Outpatient claims will be coded according to date of

service• Inpatient facility claims will be coded per date of discharge

We will monitor claims to resolve any unanticipated problems with the submission process

Monitor Claims

• We will monitor for claim denials• We will monitor editing trends for ICD-10 Coding

guidelines• We will provide feedback to the physicians regarding

supporting documentation requirements • We will monitor WC or Liability carriers for published

rules on use of ICD-9 or ICD-10 code sets

Claim Denial and Management

• Client will need to update – Templates– Order Sets– Superbills– Favorites

• Future Orders– Remove ICD-9 code add ICD-10 code

Client Responsibilities

All Conditions treated or assessed must be documented in the medical record. In addition to the documentation tips reviewed, below are more areas to document that will ensure proper ICD-10-CM code selection.

• Site specificity• Document notation of qualifiers

– Exacerbation– Manifestations– Relapse– Status– Stages

• Indicate acute or chronic• Indicate underlying or external cause factors

– Medication– Smoke– Accidents– Mechanical failure

• Laterality– Bilateral– Right – Left

Documentation – Start Now

• Episode of Care for injuries, poisoning, external causes and other conditions– Initial Encounter

• Use while the patient is receiving active treatment of the condition– Active treatment includes surgical treatment, an emergency encounter, and

evaluation and treatment by a new physician

– Subsequent Encounter• Used on encounter after the patient has received active treatment of

the condition and is receiving routine care for the condition during the healing or recovery phase.

– Medication adjustments, aftercare, device adjustments, cast change

– Sequela• Used for complications or conditions that arise as a direct result of a

condition, late effect


• Combination codes that capture– Etiology and manifestation– Related conditions– Disease, injury or other medical condition and

complications– Disease or other medical conditions and common signs or

symptoms

• Add ICD-10 Codes to patient Problem List


[email protected]

Centers for Disease Control and Prevention (ICD-10-CM)http://www.cdc.gov/nchs/icd/icd10cm.htm

Questions

mailto:[email protected]

http://www.cdc.gov/nchs/icd/icd10cm.htm

http://www.cdc.gov/nchs/icd/icd10cm.htm

Cardiology ICD-10 CM Training. ICD-10-CM will be valid for dates of service on or after October 1,...

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Transcript of Cardiology ICD-10 CM Training. ICD-10-CM will be valid for dates of service on or after October 1,...