Cardiology Coding Alert

ICD-9 code 585 will be an "invalid" code, meaning you will not be able to report it as a three-digit diagnosis and are required to add the fourth digit.

"The renal failure codes add a much needed change to reflect the specificity now made by nephrologists with regard to how far along a patient is toward total failure," says Morgan Hause, CCS, CCS-P, privacy and compliance officer for Urology of Indiana LLC in Indianapolis.

Warning: Clinicians will debate whether to use the stage-V or end-stage renal disease code. The best advice is to look to your physician's documentation, which will have to increase in specificity to accommodate for these codes. 

3. Notice This Minute Hypertension Revision

If you're reporting hypertension, you're likely using codes such as 404.01 (Hypertensive heart and renal disease, malignant, with heart failure). ICD-9 has revised these code descriptors in such a minute way that you've got to be on your toes.

For example, after Oct. 1, 404.01's descriptor will be "Hypertensive heart and kidney disease, malignant, with heart failure."

"Renal disease" no longer appears in the descriptors of codes 403.00 and 403.01, 403.10 and 403.11, 403.90 and 403.91, 404.00-404.03, 404.10-404.13, and 404.91-404.93.

Instead you'll see consistent mention of "kidney disease" rather than "renal disease" - including instances where this term appears in fifth-digit definitions.

4. No More Venting About Ventilator Troubles

In the past, coders have had no options for reporting mechanical complications of a respirator/ventilator, but as of this fall, you'll be able to report V46.14 (Mechanical complication of respirator [ventilator]). You'll also have the option of reporting V46.13 (Encounter for weaning from respirator [ventilator]).

5. Don't Lose Sleep Learning New Insomnia Codes

Sleep studies are of special interest to cardiologists because sleep disturbances, especially sleep apnea, appear to correlate directly with congestive heart failure. If lack of sleep affects your cardiology patient's condition, you'll want to get specific and report this complaint.

This usually means turning to the sleep disturbances code category 780.5x. But ICD-9 2006 vastly increases your options. "Sleep studies have become a specialty because we know that the U.S. is a sleep-deprived nation," says Sarah Mabry, CPC, PMCC, quality assurance analyst and training manager at Constella Health Sciences in Durham, N.C.
 
You'll find two kinds of sleep apnea: obstructive apnea (327.23, Obstructive sleep apnea [adult] [pediatric]), which is the most common, and central apnea (327.21, Primary central sleep apnea), related to the function of the nervous system. Obstructive apnea involves a blockage in the windpipe or trachea that bringsair into the lungs. Central apnea involves the muscles failing to receive the "go-ahead" signal to breathe from the brain.
 
Red flag: Don't confuse sleep apnea with a condition called paroxysmal nocturnal dyspnea (786.09, Dyspnea and respiratory abnormalities; other), which involves the patient waking at night gasping, and having to sit or stand to regain his breath. This condition is a classic system of heart failure. Paroxysmal nocturnal dyspnea may occur in valvular heart disease, hypertension, or other conditions affecting the left ventricle.

Warning: Be careful how you characterize sleep disorders, because you've got many options at your fingertips. One trick is to ask the following questions: 

Note: Code 780.52 exists in the "Symptoms, signs, and ill-defined conditions" section of ICD-9, while ICD-9 lists the other two (292.85 and 327.01) in the "Mental disorders" and "Nervous system" chapters. But don't be too conscious of the mental disorder placement. The reason is that "ICD-9 ran out of room and plunked these new codes into 327-330 as a nervous system type condition, as opposed to something else," Mabry says.

Note: For a full listing of the 2006 ICD-9 changes in PDF format, e-mail me at suzannel@eliresearch.com.