Cardiology Coding Alert

Know the part and know the problem to choose the proper code.

When a pacemaker battery wears down unexpectedly or a lead becomes damaged, the patient may experience shortness of breath, fatigue, and other symptoms of arrhythmia or decreased heart function. ICD-9-CM categorizes these problems as “Mechanical complication of cardiac device.” ICD-10-CM says one big category just won’t do. Here’s how the new codeset splits your choices.

ICD-9-CM Code:

• 996.01, Mechanical complication of cardiac device, implant, and graft; due to cardiac pacemaker (electrode)
  

ICD-10-CM Codes:

• T82.110-, Breakdown (mechanical) of cardiac electrode
  
• T82.111-, Breakdown (mechanical) of cardiac pulse generator (battery)
  
• T82.118-, Breakdown (mechanical) of other cardiac electronic device
  
• T82.119-, Breakdown (mechanical) of unspecified cardiac electronic device
  
• T82.120-, Displacement of cardiac electrode
  
• T82.121-, Displacement of cardiac pulse generator (battery)
  
• T82.128-, Displacement of other cardiac electronic device
  
• T82.129-, Displacement of unspecified cardiac electronic device
  
• T82.190-, Other mechanical complication of cardiac electrode
  
• T82.191-, Other mechanical complication of cardiac pulse generator (battery)
  
• T82.198-, Other mechanical complication of other cardiac electronic device
  
• T82.199-, Other mechanical complication of unspecified cardiac device
  

The appropriate 7th character is to be added to each code from category T82.-:

• A, initial encounter
  
• D, subsequent encounter
  
• S, sequela
  

ICD-9 coding rules: ICD-9 offers an inclusion note under 996.0x showing the codes apply to breakdown (mechanical); displacement; leakage; obstruction, mechanical; perforation; and protrusion. If you need to code these complications for an automatic implantable cardiac defibrillator (AICD), you would use 996.04 (Mechanical complication of automatic implantable cardiac defibrillator) instead of 996.01.

ICD-10 changes: ICD-10 offers a long list of codes that cross to both 996.01 and 996.04. The codes differ based on whether the complication is a breakdown, a displacement, or “other.” Within each of those divisions, you’ll have to choose codes based on whether the problem relates to the electrode, generator, other, or unspecified device. You’ll also have to choose a seventh character based on the encounter.

Documentation: Ensure that your providers document all the information you need to choose among the long list of new codes: the nature of the complication (breakdown, displacement, etc.), the part of the device involved (electrode, generator, etc.), which encounter it is (initial, subsequent, sequela).

Coder tips: ICD-10 Official Guidelines explain proper use of the seventh characters:

Use A, initial encounter, while the patient is receiving active treatment for the injury. “Examples of active treatment are: surgical treatment, emergency department encounter, and evaluation and treatment by a new physician.”

Use D, subsequent encounter, “for encounters after the patient has received active treatment of the injury and is receiving routine care for the injury during the healing or recovery phase. Examples of subsequent care are: cast change or removal, removal of external or internal fixation device, medication adjustment, other aftercare and follow up visits following injury treatment.”

Use S, sequela, “for complications or conditions that arise as a direct result of an injury, such as scar formation after a burn. The scars are sequelae of the burn.” When you use S, “use both the injury code that precipitated the sequela and the code for the sequela itself. The ‘S’ is added only to the injury code, not the sequela code. The ‘S’ extension identifies the injury responsible for the sequela. The specific type of sequela (e.g. scar) is sequenced first, followed by the injury code.”

Remember: CMS has finalized the ICD-10 compliance date of Oct. 1, 2014. When ICD-10 is implemented, you should apply the code set and official guidelines in effect for the date of service reported. Learn more at www.cms.gov/ICD10/ and www.cdc.gov/nchs/icd/icd10cm.htm#10update.