Anesthesia Coding Alert

Question: Our anesthesiologist provided services for a balloon valvuloplasty to treat stenosis. The physician's notes mention that rheumatic fever developed after the emergence of an untreated Streptococcus infection. Which ICD-9 code should I use for that?

Hawaii Subscriber

Answer: You should report 395.0 (Rheumatic aortic stenosis) for this situation. The note about rheumatic fever indicates that the patient probably developed that condition after he had a Streptococcus infection that went untreated. Before antibiotics became so common, this was often a widely-seen cause of valve disorders. Heart valves can become swollen and scarred when they're attacked by strep antibodies. This makes the valves susceptible to insufficiency or stenosis.

That background information is important for you to know, because ICD-9 provides different codes based on whether the valve disorder is associated with rheumatic fever. The fourth digit is necessary to differentiate between a possible diagnosis of 395.0 and 395.2 (Rheumatic aortic stenosis with insufficiency).

Also make sure you have the right procedure codes for the balloon valvuloplasty: 92986 (Percutaneous balloon valvuloplasty; aortic valve).

For the anesthesiologist's services you'll use 01926 (Anesthesia for therapeutic interventional radiological procedures involving the arterial system; intracranial, intracardiac or aortic), which is 10 units.

-- Answers to You Be the Coder and Reader Questions were provided by Scott Groudine, MD, an Albany, N.Y., anesthesiologist; Kelly Dennis, MBA, ACSAN, CANPC, CHCA, CPC, CPC-I, president of Perfect Office Solutions in Leesburg, Fla.; and Marvel J. Hammer, RN, CPC, CCS-P, ACS-PM, CHCO, owner of MJH Consulting in Denver.