# icd-9 code



## Karen48

I'm coding for a radiology group. The procedure is an MRI of the brain.The dr. states in his report, in the impression of the report the dr. states small vessel disease. Does anyone know what the correct dx would be? Thank you!


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## Shirlgam

small vessel disease (SVD) is usually associated with coronary vessels and is sometimes referred to as coronary microvascular disease 

I would verify with physician since this is not a heart scan/study.

In ICD 9 "small vessel disease" is coded as 443.9:


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## Karen48

Thanks so much.


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## BoyceSolutions

*443.9 is "peripheral"*

I know this is late coming but I disagree. 443.9 is "peripheral" ("any disease or disorderof the blood vessels outside the heart and brain") your brain is not peripheral. Your  arms, legs, hands and feet are peripheral. I know the index takes you there with that wording, but we should not code from the index.  Brain related vessel disease would be a 437 code.... 437.0 vs 437.1 depending on how it is worded in documentation.


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## preserene

Small Vessel Diseases can occur in any of the sites - the most commonest in the order of prevalence is Cerebral (brain), Coronary arteries, Pulmonary, Renal so on.
We give the name depending upon the area of the artery affected.
The case under study is related to brain . The peripheral vessel code 443.9 can go for any vessel condition in which there is a deviation from or interruption of the normal structure or function of the blood vessels outside the heart; diseases of the peripheral as opposed to the cardiac circulation.
It excludes : atherosclerosis of the arteries of the extremities (440.20-440.22) 
	  spasm of cerebral artery (435.0-435.9)
The underlying disease or pathology has to be assigned too like HTN or Non HTN , Diabetes like conditions.

Please check any condition associated with that merits it to go for reporting under 433.xx too.
Thank you


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## BoyceSolutions

*Peripheral*

I am also a clinician whose specialty area is diagnosis coding. If you go look in your icd9 book you will clearly see that peripheral does not include brain. My purpose is merely to shed light on this area. If you disagree you may contact the Coding Clinic via the AHA website for further clarification. Frankly these forums can be a breeding ground for misinformation.


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## preserene

Yes  I am sure and aware of  that the cerebro vascular diseases are separate entity from PVD. But due to the inclusion of Carotid artery in classification  in coding, it was a misconception.  I could not find this particular disease in the broad listing of the CVD.  It was grouped up into PVd for in a particular instance  as a deviation. Please forget about the misconception part of it .Let us come to the real point of the complexity  of assigning the code.
I do agree that the ICD -9 by and large depicts the clarity.
Now ,  I tried to browse the classification of Cerebro Vascular Diseases at standard www. aan.com global –a neurologist guide for ICD Coding . which gives the whole lot of cerebrovascular Diseases Coding bit by bit.  I got the whole list of the cerebrovascular diseases ;yet I did not find the terminology there. 
But there is a group which specifies the pathophysiology  prevalently occurring in Small Vessel disease, called Lacunar infarcts with parenchymal lesions (mainly Stroke related )which are better detected by the available methods( like MRI findings), than the changes in the vessels itself, which gets  the code 434. 91- cerebral artery, unspecified.
See if this could help us to have a  better understanding about this elaborate group of diseases:
[ The term cerebral small vessel disease refers to a group of pathological processes with various aetiologies that affect the small arteries, arterioles, venules, and capillaries of the brain. Age-related and hypertension-related small vessel diseases and cerebral amyloid angiopathy are the most common forms. The consequences of small vessel disease on the brain parenchyma are mainly lesions located in the subcortical structures such as lacunar infarcts, white matter lesions, large haemorrhages, and microbleeds. Because lacunar infarcts and white matter lesions are easily detected by neuroimaging, whereas small vessels are not, the term small vessel disease is frequently used to describe the parenchyma lesions rather than the underlying small vessel alterations. This classification, however, restricts the definition of small vessel disease to ischaemic lesions and might be misleading. Small vessel disease has an important role in cerebrovascular disease and is a leading cause of cognitive decline and functional loss in the elderly. Small vessel disease should be a main target for preventive and treatment strategies, but all types of presentation and complications should be taken into account].

 So, could we agree with this code assignment434.91 by and large?

Thank you for your time and patience.


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## BoyceSolutions

*434.91 is a CVA code*

A CVA (Cerebral Vascular Accident) is commonly called a stroke. No I absolutely would not agree to 434.91. The question at hand asked about "small vessel disease in the brain" via an MRI result. Having small vessel disease MIGHT lead to a 434 code but it does not yet warrant one. The 434.9 is Cerebral Artery Occlusion (this alone would be wrong because an artery is NOT a "small vessel"). It adtionally would be wrong to choose this code because the 5th digit "1" means "with cerebral infarction". No one said anything about a CVA or stroke...only small vessel disease.

Also you mention including carotid 433 if noted- this would not be noted on an MRI of the brain....carotid arteries are in your neck. Also- these are usually referred to as the "precerebral arteries" meaning the arteries before the brain. Again these are "arteries" (the largest blood vessels) vs. "small vessel".

I would highly recommend all coders take some basic anatomy and physiology classes in preparation for ICD 10 (passing the national exam only means you are prepared to know the theory and rules behind coding as tested on an open book exam, it does not mean that your education stops) as those ICD 10 codes are very specific according to anatomical location and clinical description.

The 437 codes are the best codes to represent the "small vessel disease of the brain" scenario I have found in ICD9. Luckily, ICD 10 offers more options in the "I65- I68" section. The only problem will be we will need to have providers be MORE specific for us.... exactly what TYPE of disease, WHERE anatomically, etc. will all affect the future of diagnosis code selection.


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## gost

BoyceSolutions said:


> I would highly recommend all coders take some basic anatomy and physiology classes



I can't express how much I agree with that statement.  These forums are a great help but so many coders (and others) base their advice on assumptions and faulty logic ("all dogs are animals" does not mean all animals are dogs.)  I see chart after chart coded as "unspecified" or using unlisted CPT codes just because the coder doesn't know basic anatomy and physiology, doesn't understand coding concepts, and/or doesn't want to take the time to research.

Sorry, I got a little carried away there...


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## cyeager57

BoyceSolutions said:


> I know this is late coming but I disagree. 443.9 is "peripheral" ("any disease or disorderof the blood vessels outside the heart and brain") your brain is not peripheral. Your  arms, legs, hands and feet are peripheral. I know the index takes you there with that wording, but we should not code from the index.  Brain related vessel disease would be a 437 code.... 437.0 vs 437.1 depending on how it is worded in documentation.



How would you code PAD SEVERE WITH BILATERAL  AKA?


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## cmsaral

443.9 - Peripheral Vascular Disease (Small Vessels)


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## vkvijaybtech4@gmail.com

*Diabetes*

Hi,

What is the correct code of Diabetic angiopathy with CAD.:





Vijayakumar D,CPC.


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## WReilly

BoyceSolutions said:


> I am also a clinician whose specialty area is diagnosis coding. If you go look in your icd9 book you will clearly see that peripheral does not include brain. My purpose is merely to shed light on this area. If you disagree you may contact the Coding Clinic via the AHA website for further clarification. Frankly these forums can be a breeding ground for misinformation.



Would 437.1 Other generalized ischemic cerebrovascular disease be appropriate to use?  I am also looking for a code to use for this scenario?  or 437.9 Unspecified Cerebrovascular disease or lesion NOS?


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## WReilly

*Intracranial vascular disease and chronic microangiopathic white matter changes*

Hello,

I am looking for a code for Intracranial vascular disease and chronic microangiopathic white matter changes of the cerebrum.  I have come up with two codes.  437.1 and 437.9?   I am not sure if I am even close with these codes?   

Thank you


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