Cardiology Coding Alert

Watch for when combo codes are most appropriate.

The switch to ICD-10-CM on Oct. 1, 2013, doesn't sound so far away now that 2012 is here. To be sure your practice is ready to report aortic valve disorders, check out how the new code set divides this diagnosis.

ICD-9-CM Code

• 424.1, Aortic valve disorders

ICD-10-CM Codes

• I35.0, Nonrheumatic aortic (valve) stenosis
• I35.1, Nonrheumatic aortic (valve) insufficiency
• I35.2, Nonrheumatic aortic (valve) stenosis with insufficiency
• I35.8, Other nonrheumatic aortic valve disorders
• I35.9, Nonrheumatic aortic valve disorder, unspecified

A disorder of the aortic valve refers to a problem with the valve between the aorta and the left ventricle.

ICD-9 coding rules: ICD-9 offers one code to cover aortic valve disorders not specified as rheumatic. Among the notes with the code is an excludes note pointing you instead to 395.x (Diseases of aortic valve) when documentation specifies "rheumatic."

ICD-10 changes: You'll need to choose from multiple aortic valve disorder codes in the I35.- range under ICD-10. You'll have separate codes for stenosis (I35.0), insufficiency (I35.1), stenosis with insufficiency (I35.2), other (I35.8), and unspecified (I35.9).

The notes for I35, Nonrheumatic aortic valve disorders, state:

• Aortic valve disorder of unspecified cause but with diseases of mitral and/or tricuspid valve(s) (I08.-)
• Aortic valve disorder specified as congenital (Q23.0, Q23.1)
• Aortic valve disorder specified as rheumatic (I06.-)
• Hypertrophic subaortic stenosis (I42.1).

Documentation: To support proper coding, the physician should take care to document whether the aortic valve disease is rheumatic or not rheumatic. Also alert physicians that you need to know whether the condition is congenital because it affects your code choice. Because you won't have the one-code-fits-all option for aortic valve disorders under ICD-10, your physician's documentation needs to specify the type of disorder for you to choose the most specific code.

Coder tips: Take note that when documentation shows both stenosis and insufficiency, you should choose single code I35.2 rather than reporting both I35.0 and I35.1. Also remember that insufficiency may be documented using incompetence or regurgitation. The "other" in I35.8 means the physician documented the type, but ICD-10 doesn't offer a code specific to the documented type. The "unspecified" in I35.9 means the physician did not document the type.