Anesthesia Coding Alert

Upcoming T82 codes will be more detailed than current diagnoses.

If your provider is involved with a case because of a pacemaker complication, you’ll have to sift through eight different diagnosis codes – and rely on both the anesthesia and surgical records – to find the best match under ICD-10. Start planning now for how you’ll capture the complication and encounter details the new codes will require.

Take note: The codes below apply to non-mechanical complications of heart valve prostheses or other cardiac devices, implants, or grafts (such as a pacemaker, implantable defibrillator, or bypass graft). You could see notes of complications including embolism, fibrosis, hemorrhage, pain, stenosis, or thrombosis due to the device’s presence.

ICD-9-CM Codes:

• 996.71, Other complications due to heart valve prosthesis
• 996.72, Other complications due to other cardiac device, implant, and graft

ICD-10-CM Codes:

• T82.817-, Embolism of cardiac prosthetic devices, implants and grafts
• T82.827-, Fibrosis of cardiac prosthetic devices, implants and grafts
• T82.837-, Hemorrhage of cardiac prosthetic devices, implants and grafts
• T82.847-, Pain from cardiac prosthetic devices, implants and grafts
• T82.857-, Stenosis of cardiac prosthetic devices, implants and grafts
• T82.867-, Thrombosis of cardiac prosthetic devices, implants and grafts
• T82.897-, Other specified complication of cardiac prosthetic devices, implants and grafts
• T82.9XX-, Unspecified complication of cardiac and vascular prosthetic device, implant and graft

The appropriate seventh character is to be added to each code from category T82:

A, initial encounter

D, subsequent encounter

S, sequela (Sequela is the new terminology in ICD-10-CM for late effects in ICD-9. Using the sequel extension will replace the late effects categories from ICD-9 [905-909]).

ICD-9 coding rules: ICD-9 offers two coding options. One (996.71) is specific to heart valve prosthesis complications. The other (996.72) applies to other cardiac devices, implants, and grafts specified in the documentation. The various non-mechanical complications that occur all fall under those broad codes. One important exception is coronary graft occlusion due to atherosclerosis, which you should instead code from the 414.0x range (Coronary atherosclerosis).

ICD-10 changes: The new code set adds specificity based on the type of complication and the encounter type (initial, subsequent, sequela). You probably will need to get this information from the cardiology record since the anesthesiologist might not have details about previous encounters.

Documentation: To choose the most appropriate ICD-10 code, you’ll need documentation that the complication is due to a cardiac prosthetic device, implant, or graft. You’ll need to know whether the complication is an embolism, fibrosis, hemorrhage, pain, stenosis, thrombosis, or something else. The cardiologist should be documenting this information already, so you’ll just want to be sure the information is easily accessible so you may code efficiently.