Cardiology Coding Alert

Breaking: Don't miss new myocardial infarction code I21.9.

CMS recently released its list of over 300 new ICD-10 codes. As you dig into the codes, you'll notice new options for heart failure, hypertension, and myocardial infarction.

Bottom line: The new ICD-10 codes won't go into effect until Oct. 1, 2017, so now is the perfect time to see how these changes will influence your cardiology reimbursement.

1. Adopt Brand-New Category for Heart Failure

Section I50- "Heart failure" will add a new category (I50.8-, Other heart failure). The ICD-10 manual will offer new codes to specify when patients have conditions that fall under this category such as right ventricular failure or biventricular heart failure. These additions include the following:

• I50.81- (Right heart failure)

            o I50.810 (Right heart failure, unspecified)
            o I50.811 (Acute right heart failure)
            o I508.12 (Chronic right heart failure)
            o I508.13 (Acute on chronic right heart failure)
            o I508.14 (Right heart failure due to left heart failure)

• I50.82 (Biventricular heart failure)
• I50.83 (High output heart failure)
• I50.84 (End stage heart failure)
• I50.89 (Other heart failure).

"I am excited for the new heart failure codes; the more specific, the better, says Christina Neighbors, MA, CPC, CCC, Coding Quality Auditor for Conifer Health Solutions, Coding Quality & Education Department, and member of AAPC's Certified Cardiology Coder steering committee. "This is fantastic news for coders and should reduce the number of queries or number of unspecified heart failure codes assigned within the facility or physician practice."

Neighbors adds that she has seen an increase with HFpEF (heart failure with preserved ejection fraction - diastolic heart failure); HFrEF (heart failure with reduced ejection fraction - systolic heart failure); end-stage heart failure (new ICD-10 code I50.84); and biventricular heart failure (new ICD-10 code I50.82) notated within patients' electronic medical records (EMRs).

Other Revisions: Code I50.1 (Left ventricular failure) will see a revision in the code descriptor. The revised descriptor will change to (Left ventricular failure, unspecified).

2. Uncover 6 Fresh Hypertension Codes

ICD-10 2018 also brings you new codes for pulmonary hypertension, which affects the arteries in the lungs and the heart.

Your new code choices are as follows:

• I27.20 (Pulmonary hypertension, unspecified)
• I27.21 (Secondary pulmonary arterial hypertension)
• I27.22 (Pulmonary hypertension due to left heart disease)
• I27.23 (Pulmonary hypertension due to lung diseases and hypoxia)
• I27.24 (Chronic thromboembolic pulmonary hypertension)
• I27.29 (Other secondary pulmonary hypertension).

In general, adding the new codes for cardiology is a movement in the right direction for more specificity as to the cause of the disease state, according to Mary I Falbo, MBA, CPC, CEO of Millennium Healthcare Consulting Inc.

"The new codes allow for more specific reporting, which will help the physician code to the level of specificity so he can ensure that the ordering of tests, visits, etc., meets medical necessity guidelines in terms of frequency of visits and the need for diagnostic testing," Falbo adds.

3. Don't Overlook These Myocardial Infarction Codes

You'll want to take note of the changes to myocardial infarction (MI) codes in the I21- range. The category will change from "ST elevation (STEMI) and non-ST elevation (NSTEMI) myocardial infarction" to "Acute myocardial infarction."

Additions: ICD-10 2018 will add the new code I21.9 (Acute myocardial infarction, unspecified).

Additions: Also notice the new category I21.A- (Other type of myocardial infarction), which will include the following codes:

• I21.A1 (Myocardial infarction type 2), and
• I21.A9 (Other myocardial infarction type).

For example: The cardiologist sees a patient in the emergency department and diagnoses him with an unspecified acute MI. You could code I21.9 for the MI and 99281 (Emergency department visit for the evaluation and management of a patient, which requires these 3 key components: a problem focused history; a problem focused examination; and straightforward medical decision making ...) for the hospital E/M service.

Caution: To bill 99281, the medical documentation must support that the cardiologist performed the three key components: a problem focused history, a problem focused examination, and straightforward medical decision-making. The medical documentation must also support the medical necessity of this service.

4. Watch for Word Changes in Code Descriptors

Revisions: For some code descriptors, only one word will change: "arteries" to "artery."

In other words, instead of the current descriptor of "Cerebral infarction due to unspecified occlusion or stenosis of right vertebral arteries" for I63.211, you will see the code descriptor of "Cerebral infarction due to unspecified occlusion or stenosis of right vertebral artery."

This language also holds true for:

        o I63.212 (Cerebral infarction due to unspecified occlusion or stenosis of left vertebral arteries), and
        o I63.22 (Cerebral infarction due to unspecified occlusion or stenosis of basilar artery).

5. Make Sense of Code Descriptor Language Additions

Revisions: Several cerebral infarction codes will add the word "cerebral" into the ending of the code descriptor.

For example, instead of the current descriptor of "Cerebral infarction due to thrombosis of bilateral anterior arteries" for I63.323, you will see the code descriptor of "Cerebral infarction due to thrombosis of bilateral anterior cerebral arteries."

This language also holds true for:

        o I63.333 (Cerebral infarction to thrombosis of bilateral posterior cerebral arteries), and
        o I63.513 (Cerebral infarction due to unspecified occlusion or stenosis of bilateral middle cerebral arteries) through I63.533 (Cerebral infarction due to unspecified occlusion or stenosis of bilateral posterior cerebral arteries).