Anesthesia Coding Alert

Section for codes will change in 2015, but descriptors won’t vary much. 

Certain situations can lead to higher risk for your anesthesiologist during surgeries, such as when the patient has a pacemaker or automatic implantable cardiac defibrillator (AICD). Even if that’s not the reason the surgeon is treating the patient, you still need to include the device when listing diagnoses. 

When ICD-10 is implemented in October 2015, you’ll find these codes in the “Z” section instead of “V,” but the codes themselves won’t change much. 

Currently, with ICD-9, you have two coding options for the diagnosis: 

• V45.01, Cardiac device in situ; cardiac pacemaker
• V45.02, Cardiac device in situ; automatic implantable cardiac defibrillator. 

ICD-9 coding rules: You use V45.01 and V45.02 to indicate the presence of the named devices. If the patient has an AICD with synchronous cardiac pacemaker, you should report V45.02. If the patient has a malfunction or other complication, you should instead code that condition. And if the patient presents for fitting or adjustment, you should use V53.3x (Fitting and adjustment of cardiac device).

ICD-10 changes: You’ll still rely primarily on two codes for your diagnoses in ICD-10: 

• Z95.0, Presence of cardiac pacemaker
• Z95.810, Presence of automatic (implantable) cardiac defibrillator.

ICD-10 offers a one-to-one code correspondence to your ICD-9 options. You’ll use the AICD code when the patient has an AICD with synchronous cardiac pacemaker. As with ICD-9, you should use a different code range for complications: T82.- (Complications of cardiac and vascular prosthetic devices, implants and grafts). And for adjustment or management, you’ll turn to Z45.0- (Encounter for adjustment and management of cardiac device).

Documentation: Your provider will simply need to document that the patient has a pacemaker or AICD. Double check for this detail in the surgeon’s record in case the anesthesiologist doesn’t note the condition. 

Coder tips: Although these codes have a one-to-one match between ICD-9 and ICD-10, they are not organized the same way. In other words, if you look at a list of ICD-9 codes, V45.01 is followed immediately by V45.02. In ICD-10, there are a handful of codes between Z95.0 and Z95.810, the latter of which requires two more digits than Z95.0. If you use the index and then verify your code in the tabular list, these structural changes shouldn’t put a hitch in your coding.