Cardiology Coding Alert

To report cognitive deficits following cerebrovascular disease, look to category I69-.

If your cardiologist ever documents cases of cerebrovascular accidents (CVAs) and diseases in your cardiology practice, you should always refer to the rules in the ICD-10-CM Official Guidelines for Coding and Reporting to keep your claims in tip-top shape.

Read on to learn more.

Tip 1: Follow 3 Rules for Reporting Intraoperative and Postprocedural CVA

The ICD-10-CM guidelines are very specific about when you can appropriately report an ICD-10-CM code for an intraoperative or postprocedural CVA. You should follow these rules:

• Rule 1: Your cardiologist’s medical documentation must clearly identify the cause-and-effect relationship between the medical intervention and the CVA.
• Rule 2: You should choose the appropriate ICD-10-CM code based upon whether the accident was an infarction or hemorrhage. If it is a cerebral hemorrhage, the code assignment will depend upon the procedure performed.
• Rule 3: You must know whether the CVA occurred intraoperatively or postoperatively.

Coding example: Dr. Paxton is performing an aortic valve replacement on a patient with severe aortic valve stenosis. The patient has a history of atrial fibrillation and has been on anticoagulation therapy, which was discontinued according to guidelines. During the procedure, Dr. Paxton documents there was a sudden drop in blood pressure and hemodynamic instability. Dr. Paxton discontinues the procedure, which he states in the report was due to an intraoperative cerebral vascular infarction. You should report I97.810 (Intraoperative cerebrovascular infarction during cardiac surgery) on your claim.

Tip 2: Rely on Category I69- for Sequelae of Cerebrovascular Disease

If your cardiologist documents the patient as having cognitive deficits following cerebrovascular disease, you should look to codes from category I69- (Sequelae of cerebrovascular disease).

“Category I69- is used to indicate conditions classifiable to categories I60- [Nontraumatic subarachnoid hemorrhage] through I67- [Other cerebrovascular diseases] as the causes of sequela (neurologic deficits), themselves classified elsewhere,” according to the ICD-10-CM guidelines. “These ‘late effects’ include neurologic deficits that persist after initial onset of conditions classifiable to categories I60-I67.”

Don’t miss: You should only report a code from category I69- if the patient has neurologic deficits, per the guidelines. Additionally, “the neurologic deficits caused by cerebrovascular disease may be present from the onset or may arise at any time after the onset of the condition classifiable to categories I60-I67.”

Coding example: According to your cardiologist’s documentation, the patient experiences dysphagia in its pharyngeal phase four months following a cerebral infarction. You should report I69.391 (Dysphagia following cerebral infarction).

Additionally, a note under code I69.391 tells you to report an additional code to identify the type of dysphagia, if it is known. From the medical documentation, you know that the dysphagia is pharyngeal, so you should report R13.13 (Dysphagia, pharyngeal phase).

Tip 3: Figure out Nondominant or Dominant Side

If the patient has a condition from category I69- that specifies hemiplegia, hemiparesis, or monoplegia, ICD-10-CM gives you code choices identifying whether the patient’s dominant or nondominant side was affected. However, if your cardiologist documents the patient’s affected side, but he does not specify the condition as dominant or nondominant, and the classification system does not indicate a default, you should choose the appropriate ICD-10-CM code based on the following:

• For ambidextrous patients, the default should be dominant.
• If the left side is affected, the default is non-dominant.
• If the right side is affected, the default is dominant

Coding example: The patient has monoplegia of an upper limb following a nontraumatic intracerebral hemorrhage. The cardiologist documents that the patient is affected on the left side, but he does not specify it as dominant or nondominant. According to the guidelines, you would report the non-dominant side ICD-10-CM code. So, you would report I69.134 (Monoplegia of upper limb following nontraumatic intracerebral hemorrhage affecting left non-dominant side) on your claim.

Tip 4: Use Caution When Reporting These Codes Together

Under certain circumstances you may be able to report codes from category I69- along with codes from categories I60- through I67-.

If your cardiologist documents that the patient has a current cerebrovascular disease and deficits from an old cerebrovascular disease, you can report the appropriate codes from category I69-, along with the appropriate codes from categories I60- through I67- on your claim, according to the guidelines.

Coding example: The patient has a current nontraumatic intracerebral hemorrhage in the hemisphere, subcortical, according to the cardiologist’s documentation. Additionally, the patient has attention and concentration deficit due to an old cerebral infarction that occurred a year ago. You can report I61.0 (Nontraumatic intracerebral hemorrhage in hemisphere, subcortical) followed by I69.310 (Attention and concentration deficit following cerebral infarction) on your claim.

“If your provider sees a patient and there is no documentation of a current CVA or remaining deficits following a previous CVA, you would code Z86.73 (Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits),”says Robin Peterson, CPC, CPMA, Manager of Professional Coding, Pinnacle Integrated Coding Solutions, LLC.

Tip 5: Decipher This Hypertensive Cerebrovascular Disease Situation

When your cardiologist diagnoses a patient with hypertensive cerebrovascular disease, you should report the appropriate code from categories I60- through I69- first on your claim, then you should report the appropriate hypertension code.

Coding example: A patient has hypertensive cerebrovascular disease. Your cardiologist documents essential primary hypertension and nontraumatic subarachnoid hemorrhage from the right carotid siphon and bifurcation. You should report I60.01 (Nontraumatic subarachnoid hemorrhage from right carotid siphon and bifurcation) followed by I10 (Essential (primary) hypertension) on your claim.