Cardiology Coding Alert

Your 2009 ICD-9 book will increase by at least 330 diagnosis codes, but you can breathe a sigh of relief: Of these changes, you have only one cardiology-specific code to add to your daily coding practice.

Note: Now these following codes appear in a "proposed" rule. CMS may announce more changes, so look to Cardiology Coding Alert for more details.

Your one new diagnosis code for the circulatory section is 414.3 (Coronary atherosclerosis due to lipid rich plaque).

Rationale: An interventional cardiologist can gain important diagnostic information from knowing if the patient's plaque is lipid-rich or non-lipid-rich. This will help the cardiologist decide the appropriate type of stent to use (drug eluting versus bare metal), depending on the location and amount of lipid-rich plaque.

Benefit: "I do find more specific codes helpful, especially when it is called for in the payer policies," says Lonna Maile, coding manager with Hawaii Pacific Health. The challenge is educating the physician on the need for accurately documenting diagnoses to the highest specificity.

Although you won't see any other blatant cardiology-related diagnosis codes, you might also be interested in the following new codes:

Diabetes: You've got a new set of secondary diabetes five-digit codes (249.00-249.91). These codes describe the type of complication the patient is undergoing, such as renal manifestations and peripheral circulatory disorders. The codes are divided according to whether the secondary condition is controlled or uncontrolled.

Wound disruption: This condition (also known as "wound dehiscence") means the patient has a physical separation of a surgical wound. This is a potentially serious complication. Under current ICD-9 guidelines, your cardiologist has to specify "external" or "internal" wound dehiscence. The new code is 998.30 (Disruption of wound, unspecified).

Tissue disorders: Patients who have a large traumatic hematoma may develop a seroma, a small collection of fluid. However, nontraumatic hematomas also exist, so ICD-9 2009 qualifies this with 729.90 (Disorders of soft tissue, unspecified), 729.91 (Post-traumatic seroma), 729.92 (Nontraumatic hematoma of soft tissue), and 729.99 (Other disorders of soft tissue). For instance, a patient might develop a nontraumatic hematoma after a pacemaker or defibrillator implantation.

Revision: Code 998.31 will state, "Disruption of internal operation (surgical) wound" as of Oct. 1.

Other V codes: ICD-2009 offers new options to track a patient's history involving fractures and musculoskeletal disorders (V13.51-V13.59, V15.51, V15.59), surgery (V15.29), and chemotherapy/drug therapy (V87.41-V87.49).

Want to know more? To download the full list of diagnosis code changes, visit http://www.cms.hhs.gov/ICD9ProviderDiagnosticCodes/07_summarytables.asp#TopOfPage.