# Dx code for 3 vessel disease (cardiac)



## BwitchyCoder (Jul 1, 2010)

Looking for a ICD-9 code for 3VD (three vessel disease - that's all I was given to code) and was wondering if I was in the right neighborhood with 414.11...

Would appreciate any help with this one.

Thank you!


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## crexin@bacardiac.com (Jul 1, 2010)

*3 vessel disease*

If the 3 vessels are the 3 main cardiac arteries, you are on the right track. I would verify the provider is not citing venous vessels.


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## lisammy (Jul 1, 2010)

given just 3 vessel disease you will need to use 414.00


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## BwitchyCoder (Jul 1, 2010)

*3 vessel disease "3VD"*

Thanks for the reply... on second thought, not sure I was close.

I've seen this "Three-Vessel Disease" several times before.  
It's one of those terms for a heart condition like CAD. 
Which is another non-specific term... 

This Three-Vessel Disease or Multi-Vessel Disease, means there 3 out of the 4 arteries that feed the heart 'failing'. 

What I'm wondering - is there just 1 ICD-9 code to cover this condition?

That would be asking too much right?

You see, I need to support medical necessity for a Swan Ganz Catheter Placement (93503).


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## BwitchyCoder (Jul 5, 2010)

Sadly, our billing company informs me that 414.00 (too vague?) is being denied by Medicare to support 93503.  So, I'm going to need something else. Argh!  I've got the same question for 2VD (2 Vessel Disease) so, I think it's just a term that cardiologists use instead of naming the specific arteries involved.  
I think I may go with 414.01 (for pt's that have never had a CABG) or 414.04 (for those who have)... if I can tell who's who when there are no Op Notes available to me - which is very often - and all I am given as a Diag is CAD or "3VD"  and see if that'll fly.


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## mitchellde (Jul 5, 2010)

southshore08 said:


> Sadly, our billing company informs me that 414.00 (too vague?) is being denied by Medicare to support 93503.  So, I'm going to need something else. Argh!  I've got the same question for 2VD (2 Vessel Disease) so, I think it's just a term that cardiologists use instead of naming the specific arteries involved.
> I think I may go with 414.01 (for pt's that have never had a CABG) or 414.04 (for those who have)... if I can tell who's who when there are no Op Notes available to me - which is very often - and all I am given as a Diag is CAD or "3VD"  and see if that'll fly.



You cannot assign a dx without a physician documenting this in the chart or without directive from coding guidelines.  I look at this and I see nothing more specified than cardiovascular disease.. 429.9  You cannot as a coder just make a decision to "go with" a dx code without sufficient information from the physician.


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## BwitchyCoder (Jul 6, 2010)

It's possible, I haven't give enough info -
The diag I was given was from an anesthesia record from a CABG.  

I guess you were saying you would only code 429.9 for 3VD or 2VD... but what if CAD is all your given and you're told you can't use 414.00?

I stated I was considering 414.01 or 414.04 in lieu of 414.00 for CAD because our billing company told me I shouldn't use it anymore - and I would only do so after verifying the patient's cardiac history from H&P.  Is that incorrect?

Those codes are still "CAD" - just more specific... and if there's documentation to prove them, why not use them?  I can't find them on the list of codes that do not support medical necessity for 93503.

Thanks for your input.  I appreciate all opinions.


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## mitchellde (Jul 6, 2010)

You say you are getting the dx from an anesthesia record. So now I am confused. Are coding for the physician?  The anesthesiologist?  or for the facility?  If you are coding for the physician you must get the dx from that physician's documentation for that encounter.  You may not know if the patient has had CAD in other vessels or in this vessel and you may no lok back in time for that information.  The physician must be more specific for the dx code to be more specific.  The billing company cannot direct you to change a dx when you have already coded what the documentation supports.  As I stated it may be that they have an edit that will deny any unspecified code, but if that is what you have then that is what you go with.


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