Cardiology Coding Alert

The new implementation date is set. Are your preparations on track?

Oct. 1, 2014: That's the new official compliance date for ICD-10, according to a CMS final rule published in the Federal Register. If you've been using this date as your goal since it was proposed, you should be in good shape. Keep up the momentum with these tips for proper coding of chronic ischemic heart disease.

ICD-9 Code:

• 414.8, Other specified forms of chronic ischemic heart disease

ICD-10 Codes:

• I25.5, Ischemic cardiomyopathy
• I25.6, Silent myocardial ischemia
• I25.89, Other forms of chronic ischemic heart disease

Ischemic heart disease refers to conditions that cause reduced blood flow to the heart and consequently result in damage to heart muscle. The term "ischemic" lets you know the heart isn't getting enough blood and oxygen. This is typically related to coronary disease.

ICD-9 coding rules: The ICD-9 index directs you to "other specified" code 414.8 for ischemic cardiomyopathy. A patient that has cardiomyopathy and an old myocardial infarction has ischemic heart disease (414.8). ICD-9 instructs that 414.8 applies to "Any condition classifiable to 410 [Acute myocardial infarction] specified as chronic, or presenting with symptoms after 8 weeks from date of infarction."

ICD-10 changes: ICD-10 offers you a distinct code for ischemic cardiomyopathy (I25.5) and another for silent myocardial ischemia (I25.6). When the physician documents a specific form of chronic ischemic heart disease that doesn't have a specific code, you should use I25.89.

Documentation: If your physician already takes care to document the form of chronic ischemic heart disease, then his documentation shouldn't need to change to prepare for ICD-10. You just need to be sure to check the documentation for the specific type before you choose your code.

Coder tips: Remember to check the "use additional code" notes for the I25 range before reporting these codes. The notes include the instruction to use an additional code to identify chronic total occlusion of a coronary artery (I25.82). For ischemic heart diseases (I20-I25), you should use an additional code to identify presence of hypertension (I10-I15).

And as with every case, remember to check both the index and the tabular list before choosing your code. For example, if you look up "ischemia, heart (chronic or with a stated duration of over 4 weeks)" in the ICD-10 index, you will learn that I25.9 (Chronic ischemic heart disease, unspecified), not I25.89, is the appropriate code for that diagnosis.

Remember: When ICD-10-CM goes into effect, 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. The announcement about the new implementation date was posted before Sept. 5 at https://s3.amazonaws.com/public-inspection.federalregister.gov/2012-21238.pdf. As of Sept. 5, it is published at www.federalregister.gov/articles/2012/09/05/2012-21238/adoption-of-a-standard-for-a-unique-health-plan-identifier-addition-to-the-national-provider.