Basic ICD-10-CM Coding 2013 Edition - PowerPoint Presentation

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Basic ICD-10-CM Coding2013 Edition

Chapter 12:

Diseases of the Circulatory System (I00–I99)

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Learning Objectives

Review the chapter’s extensive learning objectives and key terms.

Concepts in this chapter may require extra study time as conditions within the circulatory system may be more difficult to code than other diseases.

Coding of circulatory diseases and procedures requires particular attention to definitions and details.

At the conclusion of this chapter, what must you know about coding diseases of the circulatory systems and the related therapeutic procedures?

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ICD-10-CM Chapter 9: Diseases of the Circulatory System (I00–I99)

Chapter 9 categories are arranged in the following blocks:

I00–I02

Acute rheumatic fever

I05–I09

Chronic rheumatic heart disease

I10–I15

Hypertensive diseases

I20–I25

Ischemic heart diseases

I26–I28

Pulmonary heart disease and diseases of pulmonary circulation

I30–I52

Other forms of heart disease

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ICD-10-CM Chapter 9: Diseases of the Circulatory System (I00–I99)

ICD-10-CM categories include

I60–I69

Cerebrovascular diseases

I70–I79

Diseases of arteries,

arterioles,

and capillaries

I80–I89

Diseases of veins, lymphatic

vessels,

and lymph nodes, not elsewhere classified

I95–I99

Other and unspecified disorders of the circulatory system

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ICD-10-CM Chapter 9: Diseases of the Circulatory System (I00-I99)

Acute myocardial infarctions are identified as ST elevation (STEMI) and non-ST elevation (NSTEMI)

One codes exists for essential hypertension

Category of “Sequelae of cerebrovascular disease” identify the type of stroke that has occurred and the specific sequela or deficits it produces, such as hemiplegia or aphasia.

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Coding Instructional Notes for ICD-10-CM Chapter 9

An Excludes2 note appears in Chapter 9 to state that conditions originating in the perinatal period, certain infectious and parasitic diseases and complications of pregnancy, childbirth and the puerperium can be coded with the circulatory system codes.

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Coding Instructional Notes for ICD-10-CM Chapter 9

Under the hypertensive disease and ischemic heart disease codes, there are “use additional code to identify” notes to code exposure to

tobacco

Other codes for cardiomyopathy and paroxysmal tachycardia include note to “code first” underlying diseases, such as amyloidosis, glycogen storage disease, gout,

and such

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Coding Guidelines for ICD-10-CM Chapter 9

ICD-10-CM coding guidelines exist for

Hypertensive with heart disease

Hypertensive chronic kidney disease

Hypertensive heart and chronic kidney disease

Hypertensive cerebrovascular disease

Hypertensive retinopathy

Hypertensive secondary

Hypertension transient

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Coding Guidelines for ICD-10-CM Chapter 9

ICD-10-CM coding guidelines exist for

Hypertension controlled

Hypertension uncontrolled

Atherosclerotic coronary artery disease and angina

Intraoperative and

postprocedural

cerebrovascular accident

Sequelae of cerebrovascular disease

Code from category I69 with codes from

I60–I67

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Coding Guidelines for ICD-10-CM Chapter 9

ICD-10-CM coding guidelines exist for

Codes from category I69

Acute myocardial infarction (AMI) ST elevation myocardial infarction (STEMI) and Non-ST elevation myocardial infarction (NSTEMI)

Acute myocardial infarction unspecified

AMI documented as nontransmural or subendocardial but site provided

Subsequent acute myocardial infarction

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Coding Diseases of the Circulatory System in ICD-10-CM Chapter 9

Use additional code notes appear throughout the chapter to direct the coder to identify exposure to, history of current use, and dependence of tobacco.

Codes also specify the laterality of vessels to identify the specific location of disease

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Acute Rheumatic Fever and Rheumatic Heart Disease

Acute rheumatic fever occurs after a streptococcal sore throat

Fever, malaise, sweating, palpitation and polyarthritis occurs but it can also cause severe heart damage

Codes exist for the condition with and without heart involvement

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Acute Rheumatic Fever and Rheumatic Heart Disease

Rheumatic Chorea is the result of acute rheumatic fever and may not be evident for as long as 6 months after the infection.

Variety of symptoms are present including muscle weakness, difficulty in gripping objects, difficulty walking, and a slurred or garbled speech. Psychological and emotional symptoms may also be present

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Acute Rheumatic Fever and Rheumatic Heart Disease

Rheumatic heart disease develops after the initial attach of rheumatic fever in about 30 percent of patients

Includes inflammation of the heart values and damages the mitral valve most often and a lesser extent in the aortic,

tricuspid,

and pulmonary valves

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Acute Rheumatic Fever and Rheumatic Heart Disease

When a patient has disease of both the mitral and aortic valves, the Index to Diseases directs to codes for rheumatic heart disease as this condition often occurs after rheumatic

fever.The

condition may also involve mitral, aortic and the tricuspid valves at the same time.

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Hypertensive Disease

One code exists for hypertension,

I10

Different forms of hypertension exist in patients but one code is used for all: benign,

malignant,

or unspecified type

Definitions of hypertension include

prehypertension

and stage 1 and stage 2 hypertension

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Hypertensive Disease

Hypertensive heart disease is the secondary effects on the heart of prolonged sustained systemic

hypertension

Involves thickening of the left ventricle and results in heart failure

Review coding guidelines for hypertensive heart

disease

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Hypertensive Disease

Hypertensive chronic kidney disease is any chronic kidney disease that is due to hypertension.

ICD-10-CM presumes a cause-and-effect relationship between hypertension and chronic kidney disease.

Review coding guidelines for hypertensive chronic kidney disease.

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Hypertensive Disease

Hypertensive heart and chronic kidney disease is any heart disease due to hypertension with chronic kidney disease.

Additional codes are used to code the stage of the chronic kidney disease and type of heart failure that may exist with the hypertensive diseaes.

Review coding guidelines for hypertensive heart and chronic kidney disease.

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Hypertensive Disease

Secondary hypertension is hypertension due to another disease or underlying condition.

Two codes are required:

one

for the underlying disease and one from I15 for the hypertension

.

It

may be due to renovascular condition, other renal disorders, endocrine disorders as well as other diseases.

Review the coding guidelines

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Ischemic Heart Disease

Combination codes include atherosclerotic heart disease with angina.

Codes identify the location of the coronary artery disease and the type of angina

Unstable angina is defined as the development of prolonged episodes of anginal discomfort, usually occurring at rest and hospitalization to rule out a myocardial infarction.

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Ischemic Heart Disease

Angina pectoris is chest pain due to ischemia or loss of the blood supply to a part of the heart.

It may be triggered by exertion, stress, cold weather or digestion of a large meal.

Angina is a warning of more severe heart disease, such as myocardial infarction or congestive heart failure.

Review coding guidelines

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Acute and Subsequent STEMI and NSTEMI

Acute myocardial infarction (AMI) usually occurs as a result of a sudden inadequacy of coronary flow.

Specific coding guidelines exist for the coding of current and subsequent AMIs.

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Acute and Subsequent STEMI and NSTEMI

I21 is a myocardial infarction specified as acute or with a stated duration of 4 weeks or less from onset.

I22 is a subsequent myocardial infarction that occurs within 4 weeks of a previous AMI.

A code for I22 must be used with a code from I21

Sequencing directions are specified in the official coding guidelines

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Acute and Subsequent STEMI and NSTEMI

The diagnosis of AMI depends on the

Patient’s clinical history

Patient’s physical examination

Interpretation of the EKG

and

chest x-ray

Measurement of cardiac enzyme levels

Patient may be treated with intravenous tissue plasminogen activator (

tPA

) is treatment can be given within first 3 hours of when symptoms occur.

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Chronic Ischemic Heart Disease

Other terminology for chronic ischemic heart diseaes is atherosclerotic or arteriosclerotic heart disease.

Ischemia induces general myocardial atrophy and scattered areas of interstitial scarring.

Heart disease results from slow, progressive narrowing of the coronary arteries.

Patients with chronic ischemic heart disease may develop angina as well as a myocardial infarction.

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Chronic Ischemic Heart Disease

Atherosclerosis is the formation of lesions on the inside of the arterial walls with the accumulation of fat cells and platelets.

Another term for same condition is arteriosclerosis.

Gradual enlargement of the heart weakens the arterial wall and narrows the lumen decreasing the blood flow.

Atherosclerosis is the major cause of ischemia of the heart, brain and extremities.

Complications include stroke, congestive heart failure, angina pectoris, myocardial infarction and kidney failure.

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Chronic Ischemic Heart Disease

Additional codes are used with codes for chronic ischemic heart disease depending on the particular patient, such as:

Chronic total occlusion of coronary artery

Coronary atherosclerosis due to calcified coronary lesion

Coronary atherosclerosis due to lipid rich plaque

Various codes for exposure to or use of tobacco

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Heart Failure

Heart failure is the heart’s inability to contract with enough force to properly pump blood.

Causes of heart failure

Coronary artery disease, cardiomyopathy, hypertension or heart valve disease

Can affect the heart’s left side, right side or both

Effects of heart failure

Fluid in the lungs, kidney function hampered, blood does not circulate properly so fluid collects in tissues

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Heart Failure

Left sided or left ventricular heart failure makes the left side of the heart work harder to pump the same amount of blood

Two types of left-sided heart failure

Systolic failure: left ventricle loses its ability to contract normally

Diastolic failure: left ventricle loses its ability to relax normally

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Heart Failure

Right sided heart failure occurs as the result of left sided heart failure.

The

right side loses pumping power and blood backs up in the body’s veins and causes swelling in the legs and ankles.

Congestive heart failure causes blood to flow out of the heart at a slower rate and blood in the veins trying to return to the heart will slow down and congestion in the body tissues occurs. The patient has pulmonary

and

systemic congestion.

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Cardiac Arrhythmias and Conduction Disorders

Cardiac arrhythmias and conduction disorders identify disturbances or impairment of the normal electrical activity of the heart muscle excitation.

Types include:

Atrial fibrillation and atrial flutter

Ventricular fibrillation and paroxysmal tachycardia

Sick sinus syndrome

and

Wolf-Parkinson-White syndrome

Atrioventricular (AV) heart blocks

Supraventricular tachycardia

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Cardiac Arrest

ICD-10-CM has three codes for cardiac arrest

Cardiac arrest due to underlying cardiac condition

Cardiac arrest due to other underlying condition

Both codes have a “code first” note to code the underlying condition

Cardiac arrest, cause unspecified

Cardiac arrest codes exist in other ICD-10-CM chapters for when it occurs with abortion, in a newborn, complicating anesthesia, complicating delivery and during or after a procedure.

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Cerebrovascular Disease

Cerebrovascular disease are a variety of conditions.

Specific codes exist for various forms of cerebrovascular accidents (CVAs

)

Cerebral hemorrhage or infarction due to a thrombosis, embolism or unspecified occlusion or stenosis in the cerebral vessel

Cerebral infarction codes identify the specific cerebral artery involved and laterality (right or left side)

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Cerebrovascular Disease

Category I69, Sequelae of cerebrovascular disease, contains codes for very specific conditions that remain after the acute CVA is treated.

Late effects of cerebrovascular disease are differentiated by the type of stroke (hemorrhage or infarction.)

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Cerebrovascular Disease

Carotid artery stenosis

Occlusion and stenosis of precerebral arteries include the carotid artery and may be unilateral or bilateral. Patients may or may not have a stroke as a result.

Cerebral infarction

Codes exist for occlusion and stenosis of cerebral and precerebral arteries that result in a cerebral infarction or a stroke.

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Sequelae of Cerebrovascular Disease

Sequelae are conditions that are due to cerebral infarction and may occur at any time after the onset of the cerebrovascular disease.

These are conditions identified by codes that describe a condition that remains in the patient after the acute episode of the cerebral infarction or cerebrovascular disease is over.

These conditions may be permanent or may remain for a period of time after the acute phase of the illness is over.

The neurological deficits caused by cerebrovascular disease may be present from the onset (of the acute illness) or may arise at any time after the onset of the condition.

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Sequelae of Cerebrovascular Disease

Sequela of cerebrovascular disease are a combination of two

facts:

The cerebrovascular disease responsible for the deficit such as

nontraumatic

subarachoid

or intracerebral hemorrhage of cerebral infarction

The

type of deficit present such as cognitive defects, speech and language deficits,

monoplegia

of upper or lower limb, hemiplegia or hemiparesis, apraxia, dysphagia, facial weakness, ataxia and other paralytic syndrome.

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Sequelae of Cerebrovascular Disease

Codes for sequelae of cerebrovascular diseaes may be assigned on the same record as a patient who is treated for a current stroke and has deficits from an old stroke

Example

Patient is admitted with occlusion of cerebral arteries resulting in a cerebral infarction.

Patient has a history of a previous cerebral infarction one year ago with residual hemiplegia affecting the right dominant side

Codes for this patient would be

I63.50, Cerebral artery occlusion, unspecified, with cerebral infarction

I69.351, Hemiplegia and hemiparesis following cerebral infarction affecting right dominant side

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Venous Embolism and Thrombosis

ICD-10-CM contains very specific codes exist to acute and chronic deep and superficial vein thrombosis

Codes identify the specific vessel involved and the right or left side of the body involved.

May be documented as venous thrombo-embolism (VTE) or deep vein thrombosis (DVT)

May occur in the thorax, neck, and within the upper and lower extremities, in particular in deep and superficial veins

Review the names of the veins in the upper and lower extremity that are the deep and superficial veins

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Intraoperative and Postprocedural Circulatory Complications

Instructional notes appear under certain codes to add detail by using an additional code to further specify the condition, for example, using an additional code to identify heart failure

Types of these conditions that occur during or following an operation or procedure include:

Postcardiotomy syndrome

Cardiac functional disturbances

Cardiac arrest

Postmastectomy lymphedema syndrome

Postprocedural hypertension or heart failure

Cerebral infarction

Accidental puncture or laceration during a circulatory system procedure or during another body system procedure

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ICD-10-PCS Procedure Coding

Catheterization of the heart is a percutaneous approach to gain access to the heart for diagnostic and therapeutic procedures.

Codes are assigned for the actual root operation performed inside the heart and/or through the catheter.

Angioplasty of a coronary artery is the root operation of dilation

Imaging is the root operation is only images of the coronary vessels and structures.

If pressure measurement and sampling is performed, the root operation coded is measurement and monitoring

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ICD-10-PCS Procedure Coding

Diagnostic procedures performed via cardiac catheterization determine the size and location of a coronary lesion, evaluate left and right ventricular functions and measure heart pressures.

Therapeutic procedures performed via cardiac catheterization include the insertion of coronary artery stents or intracoronary streptokinase injections.

Index entry for catheterization, heart directs the coder to see the term measurement, cardiac A402

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ICD-10-PCS Procedure Coding

Diagnostic procedures performed during a cardiac catheterization are:

Coronary angiography

Performed on the right or left side of the heart or in a combined process

Coronary arteriography

Sones

or Judkins technique detects obstruction within coronary arteries

Ventriculography

Measures the function usually of the left ventricle in terms of ejection fraction.

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ICD-10-PCS Procedure Coding

Therapeutic procedures performed during a cardiac catheterization are:

Percutaneous transluminal coronary angioplasty

Relieve obstruction of coronary arteries by widening a narrowed area by employing a balloon-tipped catheter

May include the insertion of one or more coronary stents

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ICD-10-PCS Procedure Coding

Coronary artery bypass graft

Aortocoronary bypass brings blood from the aorta into the obstructed coronary artery using a segment of the saphenous vein

Internal mammary-coronary artery bypass graft uses the internal mammary artery to bypass the occluded coronary artery

Abdominal-coronary artery bypass using an abdominal artery

The root operation is “bypass

.”

The seventh character qualifier identifies the vessel bypassed from or the vessel that is the source of blood flow to the bypassed vessel.

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ICD-10-PCS Procedure Coding

Cardiac pacemaker

Includes three basic components inserted in the body

Pulse generator

Pacing lead

Electrode

Different types of pacemakers

Single chamber

Dual chamber

Rate responsive

Cardiac resynchronization

The root operation “insertion” is used to code the insertion of each lead and the pacemaker generator

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ICD-10-PCS Procedure Coding

Automatic Implantable Cardioverter-Defibrillators (AICD)

Includes components inserted in the body

Pulse generator

Three leads: right ventricle, right atrium and apical pericardium

The root operation “insertion”

Device character is cardiac lead, defibrillator

Generator is inserted in subcutaneous tissue and has a device value for the type of defibrillator generator used

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Exercises

Practice coding the conditions included in Chapter 9 of ICD-10-CM for diseases of the circulatory system as well as the procedures used to treat these conditions by completing the review exercises for Chapter 12.