Cardiology Coding Alert

Recent revisions and additions to cardiology diagnosis codes mean that coders will have to master the intricacies of reporting congestive heart failure (CHF). Coders who have relied heavily on 428.0 (Congestive heart failure) as an inclusive code covering a range of complications related to left heart failure, including acute edema of the lung, acute pulmonary edema, cardiac asthma and left ventricular failure, will have 12 new codes that specify particular symptoms stemming from left ventricular mechanical inadequacy. This condition causes fluid build-up in the lungs.

Beginning Oct. 1, 428.0 will be known as Congestive heart failure, unspecified. Besides the CHF code additions, there are new codes in the 443.x series (Other peripheral vascular disease). Codes 443.21-443.24 now specify dissection of the carotid, iliac, renal and vertebral arteries. Look Out for Changes in the 459 Series Code additions in the 459.1 group (Postphlebitic syndrome), which address the following conditions related to deep vein thrombosis, are particularly noteworthy for cardiology coders:

459.10 - Postphlebitic syndrome without complications

459.11 - Postphlebitic syndrome with ulcer

459.12 - Postphlebitic syndrome with inflammation

459.13 - Postphlebitic syndrome with ulcer and inflammation

459.19 - Postphlebitic syndrome with other complication. Even so, coding consultants are paying special attention to the changes in the CHF codes. (See related box for the list of codes.)

The new codes could pose problems for cardiology coders, who will have to determine whether the CHF is systolic, diastolic or combined. Moreover, if the CHF is unspecified, coders will need to decide if the condition is acute, chronic or acute on chronic. "This will be no easy task," warns Jim Collins, CHCC, CPC, a coding consultant and compliance officer with Mid-Carolina Cardiology in Matthews, N.C.

In addition, having more codes at their disposal means that many cardiology practices will have to "update their encounter forms to reflect the code changes," says Sheldrian Wayne, CPC, a cardiology coding specialist with Atlanta-based Coding Strategies Inc. These changes reflect an aggressive approach to tackling the CHF technicalities, Collins says. Without training for clinicians and deliberate provider training for coders, however, CHF coding could become difficult, leading to continued or consistent misuse of the codes and causing abnormal code utilization profiles that could hinder reimbursement. In spite of these challenges, having more codes will help cardiology practices, Wayne observes. Code additions and revisions generally mean that there is more objective and definitive information available to describe a patient's condition, "which enables us to capture better statistical data for research and other purposes," Wayne says. And providing more specific diagnoses to payers helps establish medical necessity for many procedures, she adds. Many cardiology practices fail to code to the highest level of specificity and use diagnosis codes ending in a 0, [...]