Cardiology Coding Alert

Remember: Sequencing of diagnosis codes is key.

Here are answers to the coding quiz for key cardiology diagnoses. These will help you assess how well you attempted the quiz. The explanations will give you tips and cues to making your way to the most precise diagnosis codes.

Look to This Code for Atherosclerotic Heart Disease Dx

Answer 1: You should report I25.118 (Atherosclerotic heart disease of native coronary artery with other forms of angina pectoris) for this condition.

“The Official ICD-10 Guidelines for coding atherosclerosis or coronary artery disease (CAD) with angina include a combination code for both,” explains Mari Robinson, CPC, CPMA, CRC, CCC, compliance analyst of chronic conditions at Riverside Medical Group in Newport News, Virginia. “The angina is not coded separately when both are documented as the patient’s diagnosis or condition. The specific type of angina should be documented and is coded within the combination code for CAD with angina.”

When you report a combo code for CAD with angina, you should first query the provider to confirm that is the final diagnosis, Robinson says. Additionally, if the cardiologist documents the medicine that stabilized the patient’s angina, then you should code the angina with the CAD by using the appropriate combination code I25.1XX that represents the CAD with the type of angina.

On the other hand, if the cardiologist discontinues the angina medicine, and the patient returns with symptoms of angina and the cardiologist documents the angina and/or the symptoms with the atherosclerosis, report the combination code for CAD and angina for that date of service, Robinson adds.

Reporting Hypertensive Heart and CKD With Acute Heart Failure? Read This

Answer 2: For hypertensive heart and chronic kidney disease with acute systolic (congestive) heart failure and with stage 5 CKD, you would report these codes in the following order:

I13.2 (Hypertensive heart and chronic kidney disease with heart failure and with stage 5 chronic kidney disease, or end stage renal disease)

• I50.21 (Acute systolic (congestive) heart failure)
• N18.5 (Chronic kidney disease, stage 5).

Don’t miss: You should also pay close attention to “code first” notes in ICD-10. For example, a “code first” note under category I50- (Heart failure) tells you to sequence heart failure due to hypertensive heart and CKD — II13.-.

A common error is coders not using the combination codes or the hypertensive with heart disease codes, says Carol Hodge, CPC, CDEO, CCC, CEMC, certified medical coder of St. Joseph’s Cardiology in Savannah, Georgia.

“These codes should be used to indicate hypertensive heart disease followed by the code for the type of heart failure,” Hodge adds. “Kidney disease very often occurs with hypertension and congestive heart failure, and those guidelines should be followed to correctly sequence those codes.”

Notice Code Sequencing for Accuracy

Answer 3: Absolutely. The code sequencing is key here. Since the patient’s hypertension is the cause of his heart failure, you would first report I11.0 (Hypertensive heart disease with heart failure). Then, you would report an additional code from the I50- (Heart failure) series to identify the specific type of heart failure. In this case, the patient’s heart failure is I50.1 (Left ventricular failure, unspecified).

In the ICD-10 manual, you will see that all the I50- codes come with a code first note that states I50.1 must always be reported after I11.0, when appropriate.

Remember: Code first notes indicate the primary reason for the diagnosis. They indicate the main cause for this other diagnosis. The code first note, then, says that this disease or illness has caused this other disease or illness. So, you would report I11.0 before I50.1 if hypertension was the cause of the heart failure.

Observe This Code for MI Type 5

Answer 4: You should report I21.A9 (Other myocardial infarction type) for MI type 5. If you look under this code in the ICD-10 manual, you will see that MI type 5 is an included condition for I21.A9. Other included diagnoses with this code are as follows:

• Myocardial infarction associated with revascular­ization procedure
• Myocardial infarction type 3
• Myocardial infarction type 4a
• Myocardial infarction type 4b
• Myocardial infarction type 4c.

Don’t miss: Category I21.A9 has a few specific instructions for you to follow.

First, you should also code first any known complications, if applicable. The ICD-10 manual lists the following as examples: acute stent occlusion (T82.897-); acute stent stenosis (T82.857-); acute stent thrombosis (T82.867-); cardiac arrest due to underlying cardiac condition (I46.2); complication of percutaneous coronary intervention (PCI) (I97.89); and occlusion of coronary artery bypass graft (T82.218-).

Additionally, you should follow the “Code first” note related to complications and for coding of postprocedural myocardial infarctions during or following cardiac surgery.