Cardiology Coding Alert

Report I30.1 for infective pericarditis.

When you encounter pericarditis in the documentation, you will need to become familiar with the myriad of ICD-10-CM codes available for reporting this condition, as well as the CPT^® codes for surgery options.

Take a look at these helpful tips that will keep your pericarditis coding on the up and up.

Tip 1: Focus on Pericarditis Definition

Pericarditis is the inflammation of the pericardium — the sac-like structure with two thin layers of tissue that surrounds the heart to hold it in place and help it work properly. Pericarditis can be acute onset, incessant, chronic, or recurrent. Acute pericarditis happens suddenly and doesn’t last long (usually less than four to six weeks. Chronic pericarditis will develop over a long period and may take your cardiologist longer to treat.

Common symptoms of pericarditis are fever, palpitations, sudden onset of severe chest pain, malaise, dyspnea, chills, anxious feeling, grating sound, weakness, and possible tachycardia.

There are multiple causes of pericarditis, such as infection, autoimmune disorders, chest injury, cardiac surgery, viruses, bacteria, rheumatic fever, and malignant neoplastic disease. Pericarditis can also be secondary to a myocardial infarction (MI).

Tip 2: Rely on These ICD-10-CM Codes for Pericarditis

Report the following ICD-10-CM codes when reporting pericarditis:

• I30.0 (Acute nonspecific idiopathic pericarditis)
• I30.1 (Infective pericarditis). Code I30.1 also includes pneumococcal pericarditis, pneumopyopericardium, purulent pericarditis, pyopericarditis, pyopericardium, pyopneumopericardium, staphylococcal pericarditis, streptococcal pericarditis, suppurative pericarditis, and viral pericarditis. Per ICD-10-CM, when reporting I30.1, you should use an additional code from B95- (Strepto­coccus, Staphylococcus, and Enterococcus as the cause of diseases classified elsewhere) through B97- (Viral agents as the cause of diseases classified elsewhere) to identify the infectious agent, when known.
• I30.8 (Other forms of acute pericarditis)
• I30.9 (Acute pericarditis, unspecified)
• I31.0 (Chronic adhesive pericarditis). Code I31.0 also includes accretio cordis, adherent pericardium, and adhesive mediastinopericarditis.

Tip 3: Remember Common Complications Associated With Pericarditis

Inflammation of the pericardium may be associated with the following complications:

• I31.1 (Chronic constrictive pericarditis). Chronic constrictive pericarditis lasts more than three months. It leads to scar-like tissue forming throughout the pericardium. As the pericardium becomes stiff and unable to move properly, the scarred tissue compresses the heart and prevents it from functioning properly.
• I31.2 (Hemopericardium, not elsewhere classified)
• I31.3 (Pericardial effusion (noninflammatory)
• I31.31 (Malignant pericardial effusion in diseases classified elsewhere). Code first the underlying neoplasm with neoplasm codes C00- through D94-, per ICD-10-CM.
• I31.39 (Other pericardial effusion (noninflammatory)). This code also includes chylopericardium.
• I31.4 (Cardiac tamponade). Cardiac tamponade occurs if too much fluid collects in the pericardial sac, which puts pressure on the heart. This, in turn, prevents the heart from properly filling with blood, so less blood leaves the heart, causing a sharp drop in blood pressure.
• I31.8 (Other specified diseases of pericardium). This code includes epicardial plaques and focal pericardial adhesions.
• I31.9 (Disease of pericardium, unspecified). This code includes pericarditis (chronic) NOS.

“Before selecting the correct code(s) from the categories above, be sure to review the list of Inclusive terms, along with Code First, Excludes1, and Excludes2 notes,” says Robin Peterson, CPC, CPMA, manager of professional coding and compliance services, Pinnacle Enterprise Risk Consulting Services, LLC in Centennial, Colorado.

Tip 4: Providers Use Specific Diagnosis Tools

During the exam, the provider will first ask the patient questions like if they have had a recent respiratory infection or flu-like illness, a recent heart attack or injury to their chest, or another medical condition. If the patient has chest pain, then the provider will ask them how it feels, the location, and whether it worsens when they lie down, breathe, or cough. If the patient has a pericardial rub, which is the sound of the pericardium rubbing against the outer layer of the heart, this could be a good indication that they have pericarditis.

Common tests providers perform to diagnose pericarditis include the following:

• Electrocardiogram (EKG) — This test detects and records the heart’s electrical activity.
• Chest X-ray — This test takes pictures of the inside of the chest, including the heart, lungs, and blood vessels. These pictures can show whether the patient has an enlarged heart — a sign of excess fluid in the pericardium.
• Echo — This test uses sound waves to create pictures of the heart, showing the size, shape, and how well it’s working. It can show fluid build-up in the pericardium.
• Cardiac CT — This test takes a clear, detailed picture of the heart and pericardium and helps to rule out other causes of chest pain.
• Cardiac MRI — This test uses magnets and radio waves to form detailed pictures of the organs and tissues. It can show changes in the pericardium.

Step 5: Rely on These CPT^® Codes for Surgery

Patients who have serious complications from pericarditis may need treatments that require hospital stays.

For example, physicians can treat cardiac tamponade or pericardial effusion with a procedure called pericardiocentesis, which you would report with 33016 (Pericardiocentesis, including imaging guidance, when performed). During a pericardiocentesis, a needle or tube, called a catheter, is inserted into the chest wall to remove excess fluid in the pericardium. Imaging guidance, if performed, is included with this code, so do not report it separately.

For constrictive pericarditis, the provider may have to perform a pericardiectomy; this is only done when symptoms become severe. When reporting a pericardiectomy, it is important to determine whether cardiopulmonary bypass (CPB) was performed in each scenario.

Report 33030 (Pericardiectomy, subtotal or complete; without cardiopulmonary bypass) for a pericardiectomy without CPB.

On the other hand, report 33031 (Pericardiectomy, subtotal or complete; with cardiopulmonary bypass) for a pericardiectomy with CPB.