Cardiology Coding Alert

ICD-10-CM can be tricky due to the sheer number of codes and the specificity required. This is especially true of aortic aneurysms since new characters were added to the existing codes this year. Not only do you have to know the exact location of the aortic aneurysm to report the correct code, but you must also know if it’s ruptured or not.

Follow these tips to keep your aortic aneurysm claims on the up and up.

Tip 1: First, Define Aortic Aneurysms for Clarity

An aortic aneurysm occurs in the aorta, which is the main blood vessel leading from the heart to the abdomen, pelvis, and legs, says Carol Hodge, CPC, CPMA, CDEO, CCC, CEMC, CPB, CFPC, COBGC, senior documentation specialist at St. Joseph’s/ Candler Medical Group. An aneurysm is a bulge or ballooning in part of the artery wall. This causes the wall of the artery to weaken and can eventually rupture which can be life threatening.

An aortic aneurysm is an enlargement, or dilatation, of the aorta to 1.5 times its normal size, adds Catherine Brink, BS, CPC, CMM, president of Healthcare Resource Management in Spring Lake, New Jersey.

There are three types of aortic aneurysms, and they are based on their location on the aorta: thoracic, abdominal, and thoracoabdominal.

Tip 2: Dial Into Aortic Aneurysm ICD-10-CM Codes

Effective on October 1 of this year, ICD-10-CM added a plethora of new codes with a 5th character, providing more detail about the anatomic site of the aneurysm.

For each of the thoracic codes, the 5th character adds the following anatomic information:

• 1 Ascending aorta
• 2 Aortic arch
• 3 Descending thoracic aorta

For the abdominal aortic aneurysm codes, look at these 5th digit additions:

• 1 Pararenal
• 2 Juxtarenal
• 3 Infrarenal

For thoracoabdominal aortic aneurysm codes, new 5th digit options include the following:

• 1 Supraceliac
• 2 Paravisceral

Therefore, your ICD-10-CM code choices for aortic aneurysms include the following:

• Thoracic aortic aneurysms: I71.10 (Thoracic aortic aneurysm, ruptured, unspecified)-I71.13 (Aneurysm of the descending thoracic aorta, ruptured) and I71.20 (Thoracic aortic aneurysm, without rupture, unspecified)-I71.23 (Aneurysm of the descending thoracic aorta, without rupture)
• Abdominal aortic aneurysms: I71.30 (Abdominal aortic aneurysm, ruptured, unspecified)-I71.33 (Infrarenal abdominal aortic aneurysm, ruptured) and I71.40 (Abdominal aortic aneurysm, without rupture, unspecified)-I71.43 (Infrarenal abdominal aortic aneurysm, without rupture)
• Thoracoabdominal aortic aneurysms: I71.50 (Thoracoab­dominal aortic aneurysm, ruptured, unspecified)-I71.52 (Paravisceral aneurysm of the abdominal aorta, ruptured) and I71.60 (Thoracoabdominal aortic aneurysm, without rupture, unspecified)-I71.62 (Paravisceral aneurysm of the abdominal aorta, without rupture)

Reporting aortic aneurysms has always been challenging, but is even more challenging with new ICD-10-CM codes, Hodge says. You must first determine the location of the aneurysm, such as thoracic or abdominal.

“Abdominal aneurysms require even more specificity such as pararenal or juxtarenal,” Hodge explains. “Then it must be determined if the aneurysm is ruptured or without rupture.”

You need to determine whether thoracic aneurysm are in the ascending aorta, aortic arch, or descending aorta, according to Hodge. You’ll code thoracoabdominal aneurysms based on locations such as supraceliac, paravisceral, and whether they are ruptured or without rupture.

Tip 3: Solve These Common Coding Challenges With Expert Advice

Some of the coding challenges when it comes to reporting aortic aneurysms are teaching providers to document the exact location of the aneurysm, especially with the new codes available, Hodge says. Often providers will simply document aortic aneurysms, so they need to be educated to be very specific.

Ensuring your cardiologist is documenting the location of the aortic aneurysm is important since there are different ICD-10-CM codes depending on the location, Brink reiterates.

Knowing there are code first guidelines for syphilitic aortic aneurysm (A52.01) and traumatic aortic aneurysm (S25.09 and S35.09) is also important, according to Hodge.

Coders need to have a good understanding of anatomy and physiology of aorta aneurysms and location, Brink adds. The ICD-10-CM code is specific to location and if the aneurysm has ruptured. The documentation by the provider should be specific for type and location of the aneurysm for the coder to correctly code.