Basic ICD-10-CM Coding 2013 Edition

1. Basic ICD-10-CM Coding2013 Edition Chapter 12: Diseases of the Circulatory System (I00–I99)

2. 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?

3. 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

4. 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

5. 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.

6. 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.

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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

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

16. 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

17. 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

18. 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.

19. 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.

20. 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

21. 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.

22. 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

23. 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.

24. 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

25. 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.

26. 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.

27. 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.

28. 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

29. 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

30. 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

31. 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.

32. 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

33. 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.

34. 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)

35. 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.)

36. 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.

37. 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.

38. Sequelae of Cerebrovascular Disease Sequela of cerebrovascular disease are a combination of two facts: The cerebrovascular disease responsible for the deficit such as nontraumaticsubarachoid 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.

39. 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

40. 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

41. 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

42. 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

43. 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

44. 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.

45. 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

46. 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.

47. 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

48. 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

49. 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.