Cardiology Coding Alert

Keep a close eye out for ‘secondary’ to ensure you choose the appropriate code.

When ICD-10 replaces ICD-9 in 2014, even some of your options for "other" specified diagnoses will get more specific. Here’s what to expect for "not otherwise specified" (NOS) pulmonary hypertension and heart disease coding.

ICD-9-CM Code

• 416.8, Other chronic pulmonary heart disease

ICD-10 Code

• I27.2, Other secondary pulmonary hypertension
• I27.89, Other specified pulmonary heart disease

High blood pressure affecting the vessels of the lungs is called pulmonary hypertension. Related issues may include heart failure and blood clots. It also makes the right side of the heart work harder. If pulmonary hypertension is identified as secondary, that means it is caused by another medical problem.

ICD-9 coding rules: Instructions with 416.8 tell you that the code is appropriate for pulmonary hypertension NOS and secondary pulmonary hypertension.

ICD-10 changes: Under ICD-10, pulmonary hypertension NOS is coded to I27.2, which is also appropriate for "other secondary pulmonary hypertension." You should add a code for the underlying condition when reporting the secondary code. Other specified pulmonary heart disease is coded to I27.89.
Documentation: Whether you’re using ICD-9 or ICD-10, the clinician should specify whether the pulmonary hypertension is primary (idiopathic) or secondary. For secondary hypertension, the physician should document the underlying cause.

Coder tips: Codes I27.2 and I27.89 are both "other" codes, meaning the documentation indicates the type but there isn’t a specific code for that type. You should check the ICD-10 index and the tabular (particularly I26-I28, Pulmonary heart disease and diseases of pulmonary circulation) to confirm you have the most appropriate code. For example, you should code chronic cor pulmonale to I27.81 (Cor pulmonale [chronic]).

Remember: CMS has finalized the ICD-10 compliance date of Oct. 1, 2014. 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.