Basic ICD 10 CMPCS and ICD9 CM Coding

Basic ICD 10 -CM/PCS and ICD-9 -CM Coding, 2015 Edition Chapter 10: Diseases of the Circulatory System © 2014

Learning Objectives • Review the chapter’s extensive learning objectives • Concepts in this chapter may require extra study time and coding of conditions within the circulatory system is more difficult than other chapters of ICD-9 -CM • 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? 2

Circulatory System—ICD-9 -CM • Common health problems • Diseases o Heart and great vessels o Cerebrovascular system o Arteries and veins o Lymphatics 3

Acute Rheumatic Fever—ICD-9 -CM • • • 4 ICD-9 -CM Codes 390– 392 Streptococcal sore throat Group A streptococcus hemolyticus Fever, malaise, sweating, palpitations Polyarthritis Potential for significant heart valve damage

Chronic Rheumatic Heart Disease—ICD -9 -CM Categories 393– 398 • • 5 Develops in patients with past rheumatic fever Pericarditis Weakening of myocardium Symptomatic heart murmur

Chronic Rheumatic Heart Disease (continued) ICD-9 -CM • Rheumatic fever causes inflammation of heart valves • Result is stenosis of heart valve cusps • Majority have Mitral valve damaged • Smaller percentage have Aortic valve damaged • Fewer have Tricuspid and pulmonary valve • About 10% of patient have damage to 2 valves 6

Chronic Rheumatic Heart Disease (continued) ICD-9 -CM • When both mitral and aortic valves are involved, ICD-9 -CM Alphabetic Index refers coder to categories 393– 398 • Trust the ICD-9 -CM Alphabetic Index • Physician may describe valve disease as “nonrheumatic, ” which is not coded to 393– 398 (see category 424) 7

Hypertensive Disease—ICD-9 -CM • • Hypertension table in ICD-9 -CM Main terms: hypertension, hypertensive First column: hypertensive condition Three columns: types of hypertension o Malignant o Benign o Unspecified 8

Hypertension Definition—ICD-9 -CM • Documentation in health record must describe hypertension as malignant or benign to use code; otherwise unspecified code must be used • Definitions of hypertension o Primary or essential; cause unknown in 90% of patients with 10% due to renal disease o Secondary: caused by another disease o Commonly used measurement of 140/90 • Hypertensive = due to hypertension 9

Hypertension Definition (continued) ICD-9 -CM • Complication of hypertension include o o o Left ventricular failure Arteriosclerotic heart disease Retinal hemorrhage Cerebral vascular insufficiency Renal failure • Benign hypertension remains fairly stable over many years; can be asymptomatic until complication develops; antihypertensive drug therapy common 10

Hypertension Definition (continued) ICD-9 -CM • Malignant hypertension is less common form of the disease • Frequent or abrupt onset and often ends with renal failure or cerebral hemorrhage; complaints of headaches and vision problems • Higher blood pressure readings are common including 200/140 • Long-term survival depends on early treatment 11

Hypertensive Coding Guidelines— ICD-9 -CM • ICD-9 -CM Official Coding Guidelines • Hypertensive heart disease o ICD-9 -CM Category 402 o Certain heart conditions (429. 0–. 3, 429. 8, 429. 9) due to hypertension o Stated causal relationship: “due to” or “hypertensive” o Fifth digits: absence or presence of heart failure o Use additional code to specify type of heart failure 12

Hypertensive Heart Disease—ICD-9 -CM • Hypertension can produce secondary effects on the heart due to prolonged sustained systemic hypertension • Causal statement must exist to use ICD-9 -CM category 402 o Hypertensive cardiomegaly • Cardiomegaly caused by hypertension • 402. 90, Hypertensive heart disease o Cardiomegaly with hypertension • Cardiomegaly occurring with hypertension • 429. 3, Cardiomegaly • 401. 9, Essential hypertension, unspecified 13

Hypertensive Chronic Kidney Disease —ICD-9 -CM • Hypertension cause kidney disease • Hypertensive kidney disease o ICD-9 -CM Category 403 o ICD-9 -CM presumes cause and effect: hypertension causes chronic kidney disease o Causal statement not necessary o Hypertension (401) + chronic renal disease (585) = 403 o Fifth digits: indicate stage of chronic kidney disease present 14

Hypertensive Kidney Disease (continued) ICD-9 -CM • Hypertension with chronic kidney disease (CKD) • ICD-9 -CM 403. 90, Hypertensive kidney disease with CKD stage I through stage IV or unspecified • ICD-9 -CM 403. 91, Hypertensive kidney disease, with CKD stage V or end stage renal disease • Additional code is used to identify the stage of chronic kidney disease (ICD-9 -CM 585. 1– 585. 6) if known • Documentation does not have to include statement that chronic kidney disease is due to hypertension. It is presumed to be the fact. • It is not possible to have hypertensive kidney disease without having chronic kidney disease 15

Hypertensive Heart and Kidney Disease—ICD-9 -CM • ICD-9 -CM Category 404 o Hypertensive heart disease with hypertensive kidney disease o Can assume causal relationship between hypertension and chronic kidney disease o Heart disease must be stated as hypertensive o Fifth digits: Absence, presence, or combination of heart failure and stage of chronic kidney disease 16

Hypertensive Heart and Kidney Disease (continued)—ICD-9 -CM codes • Fifth digit of 0 = without heart failure and with chronic kidney disease (CKD) stage I through stage IV, or unspecified • Fifth digit of 1 = with heart failure and with chronic kidney disease (CKD) stage I through stage IV, or unspecified • Fifth digit of 2 = without heart failure and with chronic kidney disease (CKD) stage V or end-stage renal disease • Fifth digit of 3 = with heart failure and with chronic kidney disease (CKD) stage V or end-stage renal disease 17

Hypertensive Heart and Kidney Disease (continued)—ICD-9 -CM codes • Use additional code notes • Use additional code to specify the specific type of heart failure (428. 0– 428. 9) • Use additional code to identify the stage of chronic kidney disease (585. 1– 585. 6) 18

Hypertensive Cerebrovascular Disease —ICD-9 -CM • Hypertensive cerebrovascular disease o Two codes required o Cerebrovascular disease (430– 438) o Hypertension (401– 405) 19

Hypertensive Cerebrovascular Disease (continued)—ICD-9 -CM • Example: CVA and benign hypertension o Two codes required o 434. 91, CVA o 401. 1, Essential hypertension, benign 20

Hypertensive Retinopathy—ICD-9 -CM • Hypertensive retinopathy o Two codes required o Hypertensive retinopathy (362. 11) o Hypertension (401– 405) 21

Secondary Hypertension—ICD-9 -CM • Secondary Hypertension is caused by another disease o Two codes required with ICD-9 -CM o Underlying condition, such as renovascular disease, kidney stone, or brain tumor o Secondary hypertension (405) o Sequencing of codes determined by the reason for the admission or encounter 22

Transient Hypertension—ICD-9 -CM • Transient hypertension/elevated blood pressure • Elevated blood pressure reading without diagnosis of hypertension • Symptom code used (ICD-9 -CM code 796. 2) • Transient hypertension of pregnancy (ICD-9 CM code 642. 3 x) code used if patient is pregnant 23

Hypertension: Controlled or Uncontrolled—ICD-9 -CM • No code available to describe controlled or uncontrolled hypertension • This type of statement usually refers to an existing state of hypertension under control by therapy 24

Ischemic Heart Disease (410– 414) ICD 9 -CM • Synonymous terms o Arteriosclerotic heart disease (ASHD) o Coronary ischemia o Coronary artery disease (CAD) • Insufficient blood flow due to arteriosclerotic narrowing of the coronary arteries • Use additional code for hypertension 25

Ischemic Heart Disease (410– 414) (continued) ICD-9 -CM • Three forms of heart disease o Acute myocardial infarction (AMI) o Angina pectoris o Chronic ischemic heart disease 26

Acute Myocardial Infarction (410) ICD -9 -CM • Fourth digit: Specific site of heart involved • Fifth digit: Episode of care o Review fifth-digit code descriptions in coding book carefully o 0 Episode of care unspecified • Fifth digit of 0 should be rarely used; documentation of the episode of care should be found in the patient’s health record 27

Acute Myocardial Infarction (410) (continued) ICD-9 -CM • Fifth digit: Episode of care o 1 Initial episode of care First episode of care (regardless of facility site) Used until the patient is discharged from acute care setting Acute care includes transfers between acute care hospitals Includes transfers from acute care hospital to long-term acute care hospitals (LTACH) and subsequent discharge from LTACH • Within first 8 week period • • 28

Acute Myocardial Infarction (410) (continued) ICD-9 -CM • Fifth digit: Episode of care o 2 Subsequent episode of care • Further evaluation, treatment, or observation within eight weeks of initial treatment • Includes treatment in skilled nursing facility, intermediate care facility, home care, rehabilitation hospital or unit, or hospice • Also used for readmission to acute care hospital from nonacute setting or from home during first 8 weeks period 29

Acute Myocardial Infarction (410) (continued) ICD-9 -CM • Aborted myocardial infarction, 411. 1 • ST elevation myocardial infarction (STEMI) • Non-ST elevation myocardial infarction (NSTEMI) • Acute coronary syndrome is an imprecise term; ranges from STEMI and NSTEMI to angina 30

Angina (411 and 413) ICD-9 -CM • Angina (411, 413) o Chest pain due to ischemia of the heart o Subcategory 411. 1, Unstable angina o Category 413, Angina pectoris • Sequencing rules o Known cause of angina is sequenced first o Angina may not be coded when considered an inherent part of the condition 31

Chronic Ischemic Heart Disease (414) ICD-9 -CM • Coronary arteriosclerosis or arteriosclerotic heart disease (414. 0) o Fifth digit used to identify whether the arteriosclerosis is present in a native artery or in a bypass graft • 414. 00, Coronary artery disease with no information in the record as to location of disease • 414. 01, Coronary artery disease in a patient with no history of coronary artery bypass surgery 32

Chronic Ischemic Heart Disease (414) (continued) ICD-9 -CM • Coronary arteriosclerosis (414. 0) • 414. 02, Coronary artery disease in an autologous vein bypass graft • 414. 03, Coronary artery disease in a nonautologous vein bypass graft • 414. 04, Coronary artery disease in an internal mammary artery used for a bypass graft • 414. 05, Coronary artery disease in a bypassed vessel but not known if graft was arterial or venous 33

Chronic Ischemic Heart Disease (414) (continued) ICD-9 -CM • Chronic total occlusion of coronary artery (414. 2) • Used as an additional diagnosis code • Used to code the patient with coronary atherosclerosis who has a complete blockage of a coronary artery • Increased risk of myocardial infarction or death • Treated with angioplasty and/or coronary stent placement but procedure is more difficult in patients with chronic total occlusion of the coronary artery 34

Chronic Ischemic Heart Disease (414) (continued) ICD-9 -CM • Coronary atherosclerosis due to lipid rich plaque (414. 3) • Used to code the patient with coronary atherosclerosis due to a specific form of plaque within the vessel • Important information for the cardiologist to determine the most appropriate type of stent to place within the vessel • Code used in addition to a code for the location and type of coronary atherosclerosis that exists in the patient (414. 00– 414. 07) 35

Heart Failure—ICD-9 -CM • Heart failure is the heart’s inability to contract with enough force to properly pump blood • Cause may be coronary artery disease, past myocardial infarction, cardiomyopathy, hypertension, or heart valve disease • Three effects: o Pressure in the lungs is increased o Kidney function is hampered o Blood is not properly circulated throughout the body 36

Heart Failure (continued)—ICD-9 -CM • Signs and symptoms are not coded in addition to heart failure o Sudden weight gain, Shortness of breast o Walking up breathless at night, trouble sleeping o Cough especially when lying down o Increased fatigue and weakness o Dizziness and fainting o Swollen feet, ankles, legs o Nausea with abdominal swelling, pain, tenderness 37

Heart Failure (continued)—ICD-9 -CM • Left-sided Heart Failure o Left side of heart must work harder to pump blood o Systolic heart failure occurs when left ventricle loses its ability to contract normally. Heart cannot pump blood with sufficient force to push blood into circulation o Diastolic heart failure is when left ventricle loses its ability to relax and heart cannot fill with blood during resting period between each beat 38

Heart Failure (continued)—ICD-9 -CM • Right-sided Heart Failure usually occurs as a result of left-side failure • When left ventricle fails, increased fluid pressure is transferred back through the lung, damaging the heart’s right side • When right side loses pumping power, blood backs up in the body’s veins, usually causing swelling in the legs and ankles 39

Heart Failure (continued)—ICD-9 -CM • Congestive heart failure occurs when blood returning through the veins backs up causing congestion in the body’s tissue. • Fluid may collect in the lungs and interferes with breathing (pulmonary edema) • Affects kidney’s ability to dispose of sodium and water 40

Heart Failure (continued)—ICD-9 -CM • Diagnostic tests for heart failure o Chest x-ray, echocardiogram, urinalysis, BUN • Treatment includes medications such as ACE inhibitors, diuretics, lower sodium diet, regular exercise, reducing alcohol consumption and quitting smoking • Heart failure is chronic condition, can be treated and managed but not cured 41

Cardiac Arrhythmias and Conduction Disorders—ICD 9 -CM • Impairments of the normal electrical activity of the heart • Classified according to the type of arrhythmia o Conduction disorders o Disturbances of cardiac rhythm • Specificity is important 42

Cardiac Arrhythmias and Conduction Disorders—ICD 9 -CM • Common arrhythmias o Atrial fibrillation and atrial flutter o Ventricular fibrillation o Paroxysmal supraventricular tachycardia o Sick sinus syndrome • Conduction disorders o Wolf-Parkinson-White syndrome o AV heart blocks 43

Cardiac Arrest (427. 5)—ICD-9 -CM • May be assigned as principal diagnosis o Patient arrives at the hospital in a state of cardiac arrest and cannot be resuscitated or only briefly resuscitated and is pronounced dead with the underlying cause of the cardiac arrest not established or unknown o This rule applies to emergency department visits as well as admissions into the hospital 44

Cardiac Arrest (427. 5) (continued)— ICD-9 -CM • May be assigned as secondary diagnosis o Patient arrives at the hospital emergency department is a state of cardiac arrest and is resuscitated and admitted with the condition prompting the cardiac arrest known, such as trauma or ventricular tachycardia. The condition causing the cardiac arrest is sequenced first. o When cardiac arrest occurs during the course of the hospital stay and the patient is resuscitated 45

Cardiac Arrest (427. 5) (continued)— ICD-9 -CM • Code for cardiac arrest is not coded when the physician documents cardiac arrest to describe an inpatient death when the cause of death is known. 46

Cerebrovascular Disease—ICD-9 -CM • • • 47 ICD-9 -CM Categories 430– 438 Insufficient blood supply to brain Classified according to type of condition Nontraumatic disease Additional code for hypertension Fifth digit indicates the presence or absence of cerebral infarction (categories 433– 434)

Cerebrovascular Disease (continued) ICD-9 -CM • ICD-9 -CM Code 434. 91 o Default code for acute cerebrovascular or cerebral vascular accident (CVA) o ICD-9 -CM presumes the CVA is a cerebral artery occlusion unless otherwise described by the physician • Review documentation for more specificity: hemorrhage, occlusion, thrombosis, embolus, etc. 48

Late Effects of Cerebrovascular Disease—ICD-9 -CM • ICD-9 -CM Combination code 438 • Describe the neurologic deficits that remain after cerebrovascular accident is treated • Original condition coded to 430– 437 • May be referred to as “old CVA” with residuals • Main term: Late, effects, (condition, such as aphasia, dysphagia, hemiplegia and so on) 49

Late Effects of Cerebrovascular Disease (continued) ICD-9 -CM • Secondary or residual conditions resulting from CVA o Aphasia, hemiplegia, monoplegia, dysphasia • Residuals are coded if present at the time of hospital inpatient discharge • Residuals that resolve prior to discharge are not coded 50

Late Effects of Cerebrovascular Disease (continued)—ICD-9 -CM • V 12. 54 o Old cerebrovascular accident with no neurologic deficits o Stroke or CVA completely resolved • Main terms in Alphabetic Index: o History (personal), disease (of), circulatory system, V 12. 50 o History (personal), infarction, cerebral, without residual deficits o Accident, cerebrovascular, healed or old, V 12. 54 o V 12. 54 code is better, more specific for past stroke 51

Venous Embolism and Thrombosis— ICD-9 -CM • • 52 Category 453 codes Venous thromboembolism (VTE) May also be documented as “DVT” More common type occurs in lower extremities but can also occur in the upper extremities, thorax and neck as well as other locations

Venous Embolism and Thrombosis (continued) ICD-9 -CM • Deep veins in the lower extremity are o Femoral, iliac, popliteal, peroneal and tibial o Located in the thigh and calf • Superficial veins in the lower extremity are o Greater and lesser saphenous veins 53

Venous Embolism and Thrombosis (continued) ICD-9 -CM • Deep veins in the upper extremity are o Brachial, radial and ulnar veins • Superficial veins in the upper extremity are o Antecubital, basilic and cephalic 54

Venous Embolism and Thrombosis (continued) ICD-9 -CM • Category 453 codes • Contain third and fourth digit codes to identify the location of VTE and acute or chronic nature • Proximal vessels: femoral, iliac, popliteal, or others in upper leg or thigh • Distal vessels: tibial, peroneal, or others in calf or lower leg 55

Venous Embolism and Thrombosis (continued) ICD-9 -CM • Acute or new VTEs require the initiation of anticoagulant therapy • Chronic or old VTEs require the continuation of anticoagulant therapy over a period of time with the VTE diagnosed in the past • Personal history of VTE means the condition has resolved or no longer exists (code V 12. 51) 56

Lower Extremity VTEs—ICD-9 -CM • Lower extremity o Deep veins with acute status • 453. 40– 453. 42 o Deep veins with chronic status • 453. 50– 453. 52 o Superficial veins • 453. 6 57

Upper Extremity VTEs—ICD-9 -CM • Upper extremity o Deep, superficial and unspecified veins with acute status • 453. 81– 453. 83 o Deep, superficial and unspecified veins with chronic status • 453. 71– 453. 73 58

Thorax and Neck Vessel VTEs—ICD-9 CM • Thorax and Neck Vessels o Acute • 453. 84– 453. 87 o Chronic • 453. 74– 453. 77 59

Other Specified VTEs—ICD-9 -CM • Other specified veins o Acute • 453. 89 o Chronic • 453. 79 60

Cardiovascular Procedures–Cardiac Cath—ICD-9 -CM Volume 3 • Cardiac catheterization (37. 21– 37. 23) o Diagnostic test to identify, measure, and verify intracardiac conditions such as coronary lesions or ventricular function • Cardiac angiography (88. 52– 88. 54) o Examines right, left, or both sides of the heart o Evaluates heart valves 61

Cardiovascular Procedures–PTCA • Percutaneous Transluminal Coronary Angioplasty • ICD-9 -CM Volume 3, Procedure code 00. 66 o Relieve obstruction of coronary arteries o Balloon dilation • Code also o o 62 Infusion of thrombolytic agent (99. 10) Insertion of stent(s) (36. 06– 36. 07) Intracoronary artery thrombolytic infusion (36. 04) Number of vascular stents inserted (00. 45– 00. 48) Number of vessels treated (00. 40– 00. 43)

Cardiovascular Procedures–Stents— ICD-9 -CM Volume 3 • In addition to the PTCA, coronary stents may be inserted o Procedure codes 36. 06, nondrug eluting stent or 36. 07, drug eluting stent • Code also o Number of vascular stents inserted (00. 45– 00. 48) o Number of vessels treated (00. 40– 00. 43) o Open chest coronary angioplasty (36. 03) o PTCA (00. 66) 63

Vascular Procedures—ICD-9 -CM Volume 3 • Percutaneous transluminal angioplasty may be performed on other arteries o Carotid, renal, femoropopliteal, and vertebral • Code 39. 50, Angioplasty of noncoronary vessels (lower extremity, mesenteric, upper extremity) • Codes 00. 61– 00. 62, Angioplasty of precerebral or intracranial vessels 64

Cardiovascular Procedures–CABG—ICD -9 -CM Volume 3 • Coronary artery bypass graft (36. 10– 36. 19) o Two main arteries that subdivide • Right coronary artery o Right marginal and right posterior descending • Left main coronary artery o Left anterior descending branch » Diagonal and septal branches o Left circumflex » Obtuse marginal, posterior descending, and posterolateral branches 65

Cardiovascular Procedures–CABG (continued)—ICD-9 -CM Volume 3 • Coronary artery bypass graft (36. 10– 36. 19) o CABG (pronounced cabbage) o Three surgical approaches • Aortocoronary bypass (graft from aorta to coronary artery) • Internal mammary–coronary artery bypass • Abdominal–coronary bypass 66

Cardiovascular Procedures–Pacemaker —ICD-9 -CM Volume 3 • Cardiac pacemakers have three basic components o Pulse generator contains the battery and electronic circuitry o Pacing lead carries stimulating electricity from the pulse generator to the stimulating lead o Stimulating lead is the metal portion of the lead that comes in contact with the heart 67

Cardiovascular Procedures–Pacemaker (continued)—ICD-9 -CM • Different types of pacemakers o Single chamber uses a single lead placed into the right atrium or right ventricle o Dual chamber uses leads inserted into both the atrium and the ventricle o Rate responsive have a pacing rate that is determined by physiological variable o Cardiac resynchronization, also known as biventricular pacing, uses three leads 68

Cardiovascular Procedures–Pacemaker (continued)—ICD-9 -CM • Cardiac Pacemakers o Two codes required for insertion • Pacemaker (37. 80– 37. 83) • Lead (37. 70– 37. 74) o Replacement pacemaker (37. 85– 37. 87) that includes the removal of old pacemaker being replaced o Removal of pacemaker (37. 89) used when no pacemaker is replaced, not a common procedure 69

Cardiovascular Procedures–Pacemaker (continued)—ICD-9 -CM • Reprogramming of pacemaker o No procedure code o Diagnosis code V 53. 31 used to describe visit 70

Cardiovascular Procedures–AICD—ICD 9 -CM Volume 3 • Automatic implantable cardioverterdefibrillator (AICD) • Special type of pacemaker that treats patients with recurring, life-threatening dysrhythmias, such as ventricular tachycardia or fibrillation 71

Cardiovascular Procedures–AICD (continued)—ICD-9 -CM Volume 3 • Electronic device consists of a pulse generator and three leads o Pulse generator contains battery o First lead senses heart rate in right ventricle o Second lead senses morphology and rhythm and defibrillates at the right atrium o Third lead defibrillates at the apical pericardium o Each device is programmed to suit each patient’s need 72

Cardiovascular Procedures–AICD (continued) ICD-9 -CM Volume 3 • Automatic implantable cardioverterdefibrillator (AICD) o Implantation (37. 94– 37. 96) o Replacement (37. 97– 37. 98) o Repositioning of leads or generator (37. 99) o Repositioning/revision of skin pocket (86. 09) 73

Cardiovascular Procedures (CRT-P, CRT -D) ICD-9 -CM Volume 3 • Implantation of cardiac resynchronization pacemaker with or without defibrillator o 00. 50 and 00. 51 • Implantation or replacement of transvenous lead or pulse generator only o 00. 52, 00. 53, 00. 54 • Biventricular pacing, CRT-P, CRT-D 74

Cardiovascular Procedures ICD-9 -CM (Angiography—Ventriculography) • Cardiac angiography and ventriculography o Study right and left atrium and ventricle functions, codes 88. 52 -88. 54 o Ventriculograms measure the ejection fraction, that is, the amount of blood ejected from the left ventricle per minute o Normal is between 55 and 70 percent o Fraction below 40 percent is usually heart failure 75

Cardiovascular Procedures (continued) ICD-9 -CM Volume 3 • Coronary arteriography o Used to detect obstruction within the coronary arteries, codes 88. 55– 88. 57 o Sones technique uses a single catheter inserted via a brachial arteriotomy o Judkins technique uses two catheters inserted percutaneously through a femoral artery 76

ICD-10 -CM Chapter 9: Diseases of the Circulatory System (I 00–I 99) • ICD-10 -CM categories include o I 00–I 02 Acute rheumatic fever o I 05–I 09 Chronic rheumatic heart disease o I 10–I 15 Hypertensive diseases o I 20–I 25 Ischemic heart diseases o I 26–I 28 Pulmonary heart disease and diseases of pulmonary circulation o I 30–I 52 Other forms of heart disease

ICD-10 -CM Chapter 9: Diseases of the Circulatory System (I 00–I 99) • ICD-10 -CM categories include o I 60–I 69 Cerebrovascular diseases o I 70–I 79 Diseases of arteries, arterioles and capillaries o I 80–I 89 Diseases of veins, lymphatic vessels and lymph nodes, not elsewhere classified o I 95–I 99 Other and unspecified disorders of the circulatory system

ICD-10 -CM Chapter 9: Diseases of the Circulatory System (I 00–I 99) • Revised terminology to describe cardiovascular conditions • Code for gangrene (I 96) moved to chapter 9 • Code for Binswager’s disease (I 67. 3) moved to chapter 9 • ICD-10 -CM hypertension codes does not include benign, malignant or unspecified type.

Coding Guidelines and Instructional Notes for ICD-10 -CM Chapter 9 • Categories I 21, I 22, and I 23 for acute myocardial infarction state the codes are used for four weeks or less from onset. This is different from the ICD 9 -CM standard of 8 week duration for AMI. • Code from I 22, Subsequent acute myocardial infarction, must be used in conjunction with a code from category I 21, ST elevation myocardial infarction and non-ST elevation MI.

Coding Guidelines and Instructional Notes for ICD-10 -CM Chapter 9 • ICD-10 -CM coding guidelines exist for o Hypertensive heart and chronic kidney disease o STEMI and NSTEMI coding o AMI documented as nontransmural or subendocardial o Subsequent MI o Atherosclerotic coronary artery disease and angina o Sequelae of cerebrovascular disease

Coding Overview for 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

Coding Overview for ICD-10 -CM Chapter 9 • Hypertensive Disease o Hypertensive table eliminated and replaced with regular Alphabetic Index entries o Only one code for hypertension exists (I 10) o Combination codes exist for hypertensive heart disease and hypertensive kidney disease

Coding Overview for ICD-10 -CM Chapter 9 • Ischemic heart disease o Combination codes include atherosclerotic heart disease with angina o I 25 category code details the location of coronary artery disease, such as native vessel or bypass graft and type of angina, such as unstable, with documented spasm and other forms of angina

Coding Overview for ICD-10 -CM Chapter 9 • Cerebrovascular disease o Very specific codes to identify various forms of cerebral vascular accidents (CVA) o Codes specify if condition is a cerebral hemorrhage or infarction due to thrombosis, embolism or unspecified occlusion or stenosis in the cerebral vessel o Cerebral infarction codes identify the specific cerebral artery involved and laterality

Coding Overview for ICD-10 -CM Chapter 9 • Cerebrovascular disease o Category I 69, Sequelae of cerebrovascular disease, contains codes for very specific conditions that remain after the acute CVA is treated o These codes specify laterality, revised code titles, addition of 6 th characters, providing greater specificity o Late effects are differentiated by type of stroke (hemorrhage, infarction)

Coding Overview for ICD-10 -CM Chapter 9 • Venous embolism, thrombosis, and thrombophlebitis o Very specific codes exist to describe acute and chronic deep and superficial vein thrombosis o Specific vessels identified, laterality included

Coding Overview for ICD-10 -CM Chapter 9 • Intraoperative and Postprocedural Circulatory Complications codes exist for o Intraoperative versus postprocedural cardiac arrest o Postprocedural hypertension o Postprocedural heart failure o Intraoperative and postprocedural cerebral infarction o Accidental puncture or laceration during a circulatory system procedure or during another body system procedure

Coding Overview for ICD-10 -CM Chapter 9 • Acute myocardial infarction o ICD-10 -CM categories I 21 and I 22 do not use a fifth digit to describe the episode of care o Instead ST elevation (STEMI) and Non-ST elevation (NSTEMI) conditions involving different parts of the heart wall and arteries o Certain current complications following STEMI and NSTEMI are reported with category I 23 codes when condition occurs within 28 days after the infarction

Coding Overview for ICD-10 -CM Chapter 9 • Acute myocardial infarction o Code from category I 22, subsequent STEMI and NSTEMI, is to be used when a patient who has had an AMI has a new AMI within the 28 day/4 week time period. A code form category I 22 must be used on conjunction with a code from category I 21, STEMI and NSTEMI o Category I 22 is never used alone

Coding Overview for ICD-10 -CM Chapter 9 • Acute myocardial infarction o Sequencing of I 21 and I 22 depends on circumstances of admission o The I 22 code should be sequenced first if it is the reason for the encounter (after encounter for initial MI) o The I 22 code would be sequenced as additional code if the subsequent MI occurs during the same encounter as the initial MI