Anesthesia Coding Alert

Peruse this primer to ensure you can pinpoint the most specific dx code.

October is here, which means ICD-10-CM 2024 code additions, deletions, and revisions are in effect. As you’re getting acquainted with the hundreds of new and revised codes, make sure to check out the cardiovascular (CV)-specific updates, which include novel options for hypertension, angina pectoris, microvascular dysfunction, and tachycardia, to name a few.

There’s a lot to unpack but don’t worry, we’re here to help you sort it all out. Read on for an overview of the cardiology-related changes and how they’ll enable you to use more specificity when reporting these diagnoses on your claims.

Meet the Parents: Converted Codes Get New ‘Kids’

Among the slew of updates for 2024 are new ICD-10-CM codes for common cardiovascular conditions that rely on an existing code — now converted to a parent code — for their taxonomy. When a code is converted to a parent code, it expands the coding possibilities under that particular diagnosis code by adding new codes with greater specificity below it.

Converted to parent

• I20.8 (Other forms of angina pectoris)

New

• I20.81 (Angina pectoris with coronary microvascular dysfunction). This code includes angina pectoris with coronary microvascular disease.
• I20.89 (Other forms of angina pectoris). This code includes angina equivalent, angina of effort, coronary slow flow syndrome, stable angina, and stenocardia.

Converted to parent

• I24.8 (Other forms of acute ischemic heart disease)

New

• I24.81 (Acute coronary microvascular dysfunction). This code includes acute (presentation of) coronary microvascular disease.
• I24.89 (Other forms of acute ischemic heart disease)

Converted to parent

• I47.1 (Supraventricular tachycardia)

New

• I47.10 (Supraventricular tachycardia, unspecified)
• I47.11 (Inappropriate sinus tachycardia, so stated) This code includes IST.
• I47.19 (Other supraventricular tachycardia). This code includes atrial (paroxysmal) tachycardia; atrioventricular [AV] (paroxysmal) tachycardia; atrioventricular re-entrant (nodal) tachycardia [AVNRT] [AVRT]; junctional (paroxysmal) tachycardia; and nodal (paroxysmal) tachycardia.

Analysis: Any time the heart is involved, the most accurate diagnosis code possible is vital to ensure the patient receives the care they need — at that moment and in future interactions with healthcare providers. Providing an ICD-10-CM code that gets past the 4th character and drills deeper with details can only help patients.

Report I1A.0 for Resistant Hypertension

The 2024 code set includes a whole new category for hypertension: I1A- (Other hypertension). Under this category, you gain new code I1A.0 (Resistant hypertension). Code I1A.0 also includes apparent treatment-resistant hypertension, treatment-resistant hypertension, and true-resistant hypertension.

Code first: Don’t miss the Code first note with I1A.0 instructing you to code first the specific type of existing hypertension, if known, such as essential hypertension (I10) or secondary hypertension (I15.-).

Don’t miss: Per the guidelines, resistant hypertension refers to the blood pressure of a patient with hypertension that remains above goal despite the use of antihypertensive medications. You should sequence a code for the specific type of existing hypertension first if known.

Know These 2 New Microvascular Dysfunction-Related Codes

You’ll find a couple of new codes related to microvascular dysfunction in 2024. First, is I25.85 (Chronic coronary microvascular dysfunction) for chronic coronary microvascular dysfunction. This code includes chronic (presentation of) coronary microvascular disease and coronary microvascular dysfunction NOS.

Also added is I21.B (Myocardial infarction with coronary microvascular dysfunction). This code also includes myocardial infarction with coronary microvascular disease, myocardial infarction with coronary microvascular dysfunction, and myocardial infarction with non-obstructive coronary arteries (MINOCA) with microvascular disease.

Don’t miss: According to the 2024 ICD-10-CM Official Guidelines for Coding and Reporting, “Coronary microvascular dysfunction (CMD) is a condition that impacts the microvasculature by restricting microvascular flow and increasing microvascular resistance.”

“As ICD-10-CM keeps adding associated conditions to current categories creating new parent and kid codes, quality of documentation is becoming imperative for capturing the specificity to report these codes accurately,” says Robin Peterson, CPC, CPMA, manager of professional coding and compliance services, Pinnacle Enterprise Risk Consulting Services, LLC in Centennial, Colorado. “As coders, we should make sure providers are familiar with the newly associated conditions to ensure this is captured in their documentation.”

Pay Attention to Revision Particulars

The 2024 code set also includes a few revisions. For example, I25.112 (Atherosclerostic heart disease of native coronary artery with refractory angina pectoris) has one small spelling change: the “s” is now a “t,” making the first word in the descriptor “atherosclerotic.” (emphasis added).

Several of the aneurysm codes are also revised. (emphasis added).

• I71.51 (Supraceliac aneurysm of the thoracoabdominal abdominal aorta, ruptured)
• I71.52 (Paravisceral aneurysm of the thoracoabdominal abdominal aorta, ruptured)
• I71.61 (Supraceliac aneurysm of the thoracoabdominal abdominal aorta, without rupture)
• I71.62 (Paravisceral aneurysm of the thoracoabdominal abdominal aorta, without rupture)

As you can see, in the above code descriptors, “thoracoabdominal” replaces “abdominal.”