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Basic ICD 10-CM/PCS and ICD-9-CM Coding, 2015 Edition

Learn coding procedures for diseases of circulatory system with a focus on cardiac and vascular issues. Explore hypertension, rheumatic heart disease, and more. Master coding guidelines and complications associated with circulatory conditions.

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Basic ICD 10-CM/PCS and ICD-9-CM Coding, 2015 Edition

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

  2. 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?

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

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

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

  6. 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

  7. 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)

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

  9. 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 • Primary or essential; cause unknown in 90% of patients with 10% due to renal disease • Secondary: caused by another disease • Commonly used measurement of 140/90 • Hypertensive = due to hypertension

  10. Hypertension Definition (continued) ICD-9-CM • Complication of hypertension include • 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

  11. 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

  12. Hypertensive Coding Guidelines—ICD-9-CM • ICD-9-CM Official Coding Guidelines • Hypertensive heart disease • ICD-9-CM Category 402 • Certain heart conditions (429.0–.3, 429.8, 429.9) due to hypertension • Stated causal relationship: “due to” or “hypertensive” • Fifth digits: absence or presence of heart failure • Use additional code to specify type of heart failure

  13. 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 • Hypertensive cardiomegaly • Cardiomegaly caused by hypertension • 402.90, Hypertensive heart disease • Cardiomegaly with hypertension • Cardiomegaly occurring with hypertension • 429.3, Cardiomegaly • 401.9, Essential hypertension, unspecified

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

  15. 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

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

  17. 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

  18. 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)

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

  20. Hypertensive Cerebrovascular Disease (continued)—ICD-9-CM • Example: CVA and benign hypertension • Two codes required • 434.91, CVA • 401.1, Essential hypertension, benign

  21. Hypertensive Retinopathy—ICD-9-CM • Hypertensive retinopathy • Two codes required • Hypertensive retinopathy (362.11) • Hypertension (401–405)

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

  23. 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 642.3x) code used if patient is pregnant

  24. 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

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

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

  27. Acute Myocardial Infarction (410) ICD-9-CM • Fourth digit: Specific site of heart involved • Fifth digit: Episode of care • Review fifth-digit code descriptions in coding book carefully • 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

  28. Acute Myocardial Infarction (410) (continued) ICD-9-CM • Fifth digit: Episode of care • 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

  29. Acute Myocardial Infarction (410) (continued) ICD-9-CM • Fifth digit: Episode of care • 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

  30. 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

  31. Angina (411 and 413) ICD-9-CM • Angina (411, 413) • Chest pain due to ischemia of the heart • Subcategory 411.1, Unstable angina • Category 413, Angina pectoris • Sequencing rules • Known cause of angina is sequenced first • Angina may not be coded when considered an inherent part of the condition

  32. Chronic Ischemic Heart Disease (414) ICD-9-CM • Coronary arteriosclerosis or arteriosclerotic heart disease (414.0) • 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

  33. 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

  34. 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

  35. 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)

  36. 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: • Pressure in the lungs is increased • Kidney function is hampered • Blood is not properly circulated throughout the body

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

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

  39. 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

  40. 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

  41. Heart Failure (continued)—ICD-9-CM • Diagnostic tests for heart failure • 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

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

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

  44. Cardiac Arrest (427.5)—ICD-9-CM • May be assigned as principal diagnosis • 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 • This rule applies to emergency department visits as well as admissions into the hospital

  45. Cardiac Arrest (427.5) (continued)—ICD-9-CM • May be assigned as secondary diagnosis • 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. • When cardiac arrest occurs during the course of the hospital stay and the patient is resuscitated

  46. 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.

  47. Cerebrovascular Disease—ICD-9-CM • 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)

  48. Cerebrovascular Disease (continued) ICD-9-CM • ICD-9-CM Code 434.91 • Default code for acute cerebrovascular or cerebral vascular accident (CVA) • 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.

  49. 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)

  50. Late Effects of Cerebrovascular Disease (continued) ICD-9-CM • Secondary or residual conditions resulting from CVA • 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

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