Cardiology Coding Alert

Check for the specific problem before using these 996.71-996.72 replacements.

If you have a patient present with a pacemaker complication after ICD-10 is implemented, you’ll have to sift through eight different codes to find the best match for his case. Be sure your practice has a plan to capture the complication and encounter details the new codes will require.

The diagnosis: The codes below apply to non-mechanical complications of heart valve prostheses or other cardiac devices, implants, or grafts, such as a pacemaker, implantable defibrillator, or bypass graft. Complications may include embolism, fibrosis, hemorrhage, pain, stenosis, or thrombosis due to the device’s presence.

ICD-9-CM Codes:

• 996.71, Other complications due to heart valve prosthesis
• 996.72, Other complications due to other cardiac device, implant, and graft

ICD-10-CM Codes:

• T82.817-, Embolism of cardiac prosthetic devices, implants and grafts
• T82.827-, Fibrosis of cardiac prosthetic devices, implants and grafts
• T82.837-, Hemorrhage of cardiac prosthetic devices, implants and grafts
• T82.847-, Pain from cardiac prosthetic devices, implants and grafts
• T82.857-, Stenosis of cardiac prosthetic devices, implants and grafts
• T82.867-, Thrombosis of cardiac prosthetic devices, implants and grafts
• T82.897-, Other specified complication of cardiac prosthetic devices, implants and grafts
• T82.9XX-, Unspecified complication of cardiac and vascular prosthetic device, implant and graft

The appropriate 7th character is to be added to each code from category T82:

• A, initial encounter
• D, subsequent encounter
• S, sequela

ICD-9 coding rules: ICD-9 offers two coding options. One (996.71) is specific to heart valve prosthesis complications. The other (996.72) applies to other cardiac devices, implants, and grafts specified in the documentation. The various non-mechanical complications that occur all fall under those broad codes. One important exception is coronary graft occlusion due to atherosclerosis, which you should instead code from the 414.0x range (Coronary atherosclerosis).

ICD-10 changes: ICD-10 makes use of seven characters to add specificity to each code. The new codeset will divide your options based on the specific type of complication. You also will need to add a seventh character specifying the encounter type (initial, subsequent, sequela). Like ICD-9, ICD-10 codes coronary graft atherosclerosis under separate ranges, which differ based on documentation of angina: I25.7- (Atherosclerosis of coronary artery bypass graft[s] and coronary artery of transplanted heart with angina pectoris) and I25.81- (Atherosclerosis of other coronary vessels without angina pectoris).

Documentation: To choose the most appropriate ICD-10 code, you’ll need documentation that the complication is due to a cardiac prosthetic device, implant, or graft. You’ll need to know whether the complication is an embolism, fibrosis, hemorrhage, pain, stenosis, thrombosis, or something else. Your physician should be documenting this information already, so you’ll just want to be sure the information is easily accessible so you may code efficiently. Take extra care to be sure you can easily distinguish whether the encounter is initial, subsequent, or sequela.

Coder tips: Unspecified complication code T82.9XX- includes “XX” as placeholders in spaces five and six to allow you to apply the seventh character as instructed.

ICD-10 Official Guidelines explain proper use of the seventh characters which specify the encounter:

• Use A, initial encounter, while the patient is receiving active treatment for the injury. “Examples of active treatment are: surgical treatment, emergency department encounter, and evaluation and treatment by a new physician.”
• Use D, subsequent encounter, “for encounters after the patient has received active treatment of the injury and is receiving routine care for the injury during the healing or recovery phase. Examples of subsequent care are: cast change or removal, removal of external or internal fixation device, medication adjustment, other aftercare and follow up visits following injury treatment.”
• Use S, sequela, “for complications or conditions that arise as a direct result of an injury, such as scar formation after a burn. The scars are sequelae of the burn.” When you use S, “use both the injury code that precipitated the sequela and the code for the sequela itself. The ‘S’ is added only to the injury code, not the sequela code. The ‘S’ extension identifies the injury responsible for the sequela. The specific type of sequela (e.g., scar) is sequenced first, followed by the injury code.”

ICD-10-CM guidelines are available at www.cdc.gov/nchs/icd/icd10cm.htm.