Cardiology Coding Alert

Hint: Numerous atherosclerosis codes will add Includes notes.

The new ICD-10-CM codes for 2021 were recently released. You will see new COVID-19 code U07.1 in this manual. Although you won’t gain any brand-new cardiology-related ICD-10-CM codes in 2021, you will see some relevant additions and revisions to the index and notes within the tabular.

Editor’s note: ICD-10-CM 2021 goes into effect on October 1, 2020, so now is the time to prep for the changes that will impact your cardiology office.

Keep Using U07.1 for COVID-19

The most important addition to the 2021 ICD-10-CM code book is also the least surprising. In October, U07.1 (COVID-19) will be recorded in the ICD-10-CM manual.

This is just a formality, however, as the code has been official since April. Experts were amazed at the quickness with which U07.1 was added to the ICD-10-CM rolls — but it made sense considering the unprecedented public health emergency (PHE) and the lack of an accurate diagnosis code for the situation.

“The speed that the ICD-10-CM Coordination and Maintenance Committee approved this new code is unprecedented,” said Betty Ann Price, BSN, RN, president and founder of Professional Reimbursement and Coding Strategies, and AHIMA-approved ICD-10-CM trainer. “The new code, U07.1, was initially assigned by the World Health Organization. Usually it requires at least a one-year process to get a new code adopted, but this went through with exceptional speed.”

The early adoption of U07.1 was necessary, however, to “fulfill the imperative need to track the diagnosis of this condition as well as its subsequent treatment,” explains Gregory Przybylski, MD, immediate past chairman of neuroscience and director of neurosurgery at the New Jersey Neuroscience Institute, JFK Medical Center in Edison, New Jersey.

In the notes beneath U07.1, coders are instructed to use an additional code to “identify pneumonia or other manifestations.” There are also several Excludes1 diagnoses as well, such as:

• B34.2 (Coronavirus infection, unspecified)
• B97.2- (Coronavirus as the cause of diseases classified elsewhere)
• J12.81 (Pneumonia due to SARS-associated coronavirus)

Note Extensive Arteriosclerosis Index Revisions

If you’re used to coding scans of the arterial vessels, such as a computed tomographic angiographies (CTAs) or magnetic resonance angiographies (MRAs), then you’re probably acutely aware of the vast array of arteriosclerosis diagnoses available within the ICD-10-CM alphabetic index and tabular. Well, as of 2021, that list of arteriosclerosis codes will be expanding to include chronic limb-threatening ischemia (CLTI), or critical limb ischemia (CLI). CLI is an advanced stage of arterial occlusive disease of the limbs, often referred to as end-stage or terminal stage.

Fortunately, you won’t have to worry about the introduction of any brand-new codes for CLI reporting. Instead, the ICD-10-CM index has included over 100 new routes to existing arteriosclerosis codes to accommodate for this condition, but you shouldn’t have too much difficulty reaching the correct area of the alphabetic index so long as you know where to look. In the ICD-10 manual, under “Arteriosclerosis, arteriosclerotic (diffuse) (obliterans) (of) (senile) (with calcification) I70.90,” you will encounter some of the following sub-terms:

• Chronic limb-threatening ischemia - see Arteriosclerosis, with critical limb ischemia;
• Critical limb ischemia

Under critical limb ischemia, you’ll code from there the highest degree of specificity. For instance, if the dictation report documents a CLI of an autologous vein bypass graft of the right leg with gangrene, you’ll report code I70.461.

Tabular changes: You’ll also see changes to the atherosclerosis notes in the tabular. For example, the Includes note for category I70.22- (Atherosclerosis of native arteries of extremities with rest pain) will add the following conditions:

• Chronic limb-threatening ischemia NOS of native arteries of extremities
• Chronic limb-threatening ischemia of native arteries of extremities with rest pain
• Critical limb ischemia NOS of native arteries of extremities
• Critical limb ischemia of native arteries of extremities with rest pain

Don’t miss: You will see additional Includes notes for numerous atherosclerosis categories including I70.22- through 170.24- (Atherosclerosis of native arteries of left

leg with ulceration); I70.26 (Atherosclerosis of native arteries of extremities with gangrene); I70.32- (Atherosclerosis of unspecified type of bypass graft(s) of the extremities with rest pain) through I70.34- (Atherosclerosis of unspecified type of bypass graft(s) of the extremities with rest pain); and I70.42- (Atherosclerosis of autologous vein bypass graft(s) of the extremities with rest pain) through I70.44- (Atherosclerosis of autologous vein bypass graft(s) of the left leg with ulceration). Note: This is not an exhaustive list.

Pinpoint Several Excludes Notes Changes to Tabular

You will also see changes to Excludes1 and Excludes2 notes in the tabular. For example, for codes I46 (Cardiac arrest), ICD-10 will revise the Excludes1 note cardiogenic shock (R57.0). This Excludes1 note will change to an Excludes2 note.

Also, code I63 (Cerebral infarction) will gain new Excludes1 note neonatal cerebral infarction (P91.82-).

Remember: An Excludes1 note means “NOT CODED HERE,” whereas an Excludes2 note means “Not included here.” A patient may have those two conditions at the same time.