Anesthesia Coding Alert

Question: Our anesthesiologist provided services for a balloon valvuloplasty to treat stenosis. I see a notation for rheumatic fever in the physician's notes. How should I code for this?

Arkansas Subscriber

Answer: You'll start by looking at which procedure code covers the service. The balloon valvuloplasty is reported using 92986 (Percutaneous balloon valvuloplasty; aortic valve).

Now work on the anesthesiologist's services during the procedure. You'll code for this using 01926 (Anesthesia for therapeutic interventional radiological procedures involving the arterial system; intracranial, intracardiac or aortic), which is 10 units.

About that rheumatic fever: Your physician's note about rheumatic fever indicates that the patient probably developed that condition after he had a Streptococcus infection that went untreated. This used to be the leading cause of valve disorders before antibiotic usage became widespread. Heart valves can become swollen and scarred when they're attacked by strep antibodies, making the valves susceptible to insufficiency or stenosis.

Good to know: This is necessary information for accurate diagnosis coding because ICD-9 provides different codes based on whether a valve disorder is associated with rheumatic fever.

Your best place to start is with 395.x (Diseases of aortic valve). You'll need to go a little further, coding the necessary fourth digit for an ultimate diagnosis of 395.0 (Rheumatic aortic stenosis).