Anesthesia Coding Alert

Today's 414.8 will soon have three more detailed options.

Anesthesiologists sometimes rely on the patient's medical condition or underlying history to help justify the need for their services during a procedure. If you learn that a patient has chronic ischemic heart disease, prepare to have extra options when ICD-10 goes into effect in October 014.

Definition: Ischemic heart disease is the term for conditions that cause reduced blood flow to the heart, resulting in damage to heart muscle. The word "ischemic" means that the heart isn't getting enough blood and oxygen; this typically is related to coronary disease.

ICD-9: Currently, you report 414.8 (Other specified forms of chronic ischemic heart disease) for these patients. A patient who has cardiomyopathy and an old myocardial infarction has a condition known as ischemic heart disease. ICD-9 guidelines instruct that 414.8 applies to "any condition classifiable to 410 [Acute myocardial infarction] specified as chronic, or presenting with symptoms after 8 weeks from date of infarction."

ICD-10 changes: Under ICD-10, you'll have three distinct choices for the conditions currently classified under 414.8. They are:

• I25.5, Ischemic cardiomyopathy
• I25.6, Silent myocardial ischemia
• I25.89, Other forms of chronic ischemic heart disease.

Knowing when to choose I25.5 or I25.6 should be simple if the physicians clearly document the patient's condition. If the physician documents a specific form of chronic ischemic heart disease that doesn't have a specific code, you'll submit I25.89.

Preparation: If your physician already takes care to document the form of chronic ischemic heart disease, then his documentation shouldn't need to change to prepare for ICD-10. You just need to be sure to check the documentation for the specific type before you choose your code.

Coder tips: Remember to check the "use additional code" notes for the I25 range before reporting these codes. The notes include the instruction to use an additional code to identify chronic total occlusion of a coronary artery (I25.82). For ischemic heart diseases (I20-I25), you should use an additional code to identify presence of hypertension (I10-I15).

And as with every case, remember to check both the index and the tabular list before choosing your code. For example, if you look up "ischemia, heart (chronic or with a stated duration of over 4 weeks)" in the ICD-10 index, you will learn that I25.9 (Chronic ischemic heart disease, unspecified), not I25.89, is the appropriate code for that diagnosis (I20-I25), you should use an additional code to identify presence of hypertension (I10-I15).