Cardiology Coding Alert

Solution on the Way

If you're looking for a better way to specify graft occlusion for heart transplant patients or a more complete list of long-term drug use codes, your wait will be over soon. Thanks to new ICD-9 codes that take effect Oct. 1, you'll have what you need to improve your signs and symptoms coding for these and other conditions.

CMS unveiled the new diagnosis codes, some of which affect cardiology practices, in the May 19 Federal Register. The ICD-9 codes are updated on Oct. 1 of each year, says Patricia E. Brooks, RHIA, a member of CMS' ICD-9-CM Coordination and Maintenance Committee.

Once the new codes are in effect, "we try to make sure that everyone in the billing office is up to date on the changes," says Rebecca Sanzone, CPC, billing manager for Midatlantic Cardiovascular Associates of Baltimore. Although some of the new diagnosis changes won't affect her office, the more information she can share with billers and physicians on those changes that will affect them, the better, she says.

Occluded Grafts and Transplants Get the Fifth Degree

The new diagnostic codes make several significant changes to the acute and chronic ischemic heart disease  codes, revising descriptors for occluded arteries in transplants or grafts and adding a new code for atherosclerosis in bypass grafts.

Code 414.06 (Of coronary artery of transplanted heart) will add the descriptor "native" to the phrase "of coronary arteries" to distinguish between atherosclerosis in native and non-native grafts. And for occluded bypass grafts in heart transplant patients, you will report new code 414.07 (Of bypass graft [artery] [vein] of transplanted heart) after Oct. 1. Cardiology coders will welcome the specificity of these codes, particularly 414.07, which is just for occluded grafts, says Terri Davis, CPC, coding supervisor for the University of Oklahoma College of Medicine. She adds that she expects to link these new codes to heart catheterization procedure codes.

Adding 414.07 changes the exclusion descriptions for several codes. The exclusions for 411.81 (Acute coronary occlusion without myocardial infarction) will be obstruction without infarction due to atherosclerosis (414.00-414.07) and occlusion without infarction due to atherosclerosis (414.00-414.07) rather than obstruction without infarction due to atherosclerosis (414.00-414.06) and occlusion without infarction due to atherosclerosis (414.00-414.06). So, you should not report the new bypass graft code (414.07) with 411.81.

Codes 440.8 (Atherosclerosis, of other specified arteries) and 447.6 (Arteritis, unspecified) will also exclude 414.07.

Make the Most of Glucose Intolerance Test Changes

If your cardiologist uses glucose intolerance testing to diagnose diabetes, you can report three new testing codes beginning Oct. 1: 790.21 (Impaired fasting glucose), 790.22 (Impaired glucose tolerance test [oral]) and 790.29 (Other abnormal glucose).

Glucose intolerance testing to treat patients before they become diabetic is becoming a hot issue in cardiology practices, according to Anne C. Karl, RHIA, CCS-P, CPC, a coding and compliance specialist with the St. Paul Heart Clinic in Mendota Heights, Minn. The new glucose intolerance codes are very specific, and this will benefit coders, she says.

Moreover, after Oct. 1, the definition for 790.2 (Abnormal glucose tolerance test) will omit "tolerance test," and the list of exclusions for 790.2 will include diabetes mellitus (250.00-250.93), dysmetabolic syndrome X (277.7), gestational diabetes (648.8x), glycosuria (791.5), and hypoglycemia (251.2).

Say Goodbye to Generic Iatrogenic Hypotension

CMS deletes 458.2 (Iatrogenic hypotension) and replaces it with more specific codes 458.21 (Hypotension of hemodialysis) and 458.29 (Other iatrogenic hypotension). Often during hemodialysis, patients develop hypotension, and these new codes will distinguish hypotension during hemodialysis from other forms of iatrogenic hypotension, says Jerome Williams Jr., MD, FACC, a cardiologist with Mid Carolina Cardiology in Charlotte, N.C.

Watch for Acute Chest Syndrome

You can report new code 517.3 (Acute chest syndrome) when the cardiologist determines that a patient's chest pains are pulmonary rather than cardiac in origin.

But pay close attention to the documentation because acute chest syndrome is a specific pulmonary condition. Acute chest syndrome is definitely not the same condition as acute coronary syndrome or acute chest pain syndrome, Williams says. Sometimes a patient with pulmonary problems, such as pneumonia or another type of lung disease, will have chest pains unrelated to the heart, he adds. Typically, you would use the 517 code series, which would include 517.3, for conditions such as pleuritic chest pain, secondary to pneumonia, so cardiologists probably would not use this code very often, he says. 

Look for Peri-, Postpartum Cardiomyopathy Codes

CMS adds a handful of new fifth-digit codes for peripartum and postpartum cardiomyopathy, a weakening of the heart muscles some women experience in the last month of pregnancy or during the first six months after delivery:

The new peri/postpartum codes are 674.50 (Peripartum cardiomyopathy, unspecified as to episode of care or not applicable), 674.51 (Peripartum cardiomyopathy, delivered, with or without mention of antepartum condition), 674.52 (Peripartum cardiomyopathy, delivered, with mention of postpartum condition), 674.53 (Peripartum cardiomyopathy, antepartum condition or complication), and 674.54 (Peripartum cardiomyopathy, postpartum condition or complication).

Because pregnancy-induced cardiomyopathy can include fatigue, shortness of breath, and water retention in the lungs or other parts of the body - symptoms common to many other diseases as well as underlying heart disease - physicians may conduct further diagnostic studies to pinpoint peripartum cardiomyopathy as the cause, Williams says. Once the physician confirms a peri/postpartum cardiomyopathy diagnosis and documents specifics about disease onset or severity, you would report the appropriate new cardiomyopathy code after Oct. 1, he says.

The changes delete "cardiomyopathy" from the list of postpartum condition descriptors under 674.8x (Other, postpartum).

Report New V Codes for Artificial Hearts, Drug Use

CMS introduces several new fifth-digit V codes, including a new code for heart assist devices and fully implantable artificial hearts under the category V43.2x (Organ or tissue replaced by other means, heart).

Beginning Oct. 1, report V43.21 (Heart assist device) when the physician diagnoses cardiac dysfunction requiring implantation of a ventricular assist device and V43.22 (Fully implantable artificial heart) for cardiac dysfunction requiring artificial heart implantation.

Davis agrees that these more specific codes will help increase coding accuracy for artificial hearts and expects to link these new codes to heart transplant procedural codes and echocardiography studies.

In addition, under the category V45.0x (Cardiac device in situ), CMS adds two exclusions: artificial heart (V43.22) and heart assist device (V43.21)

For patients on long-term antithrombotic and anti-inflammatory medications, you can use three new V codes after Oct. 1. Under category V58.6x (Long-term [current] drug use), CMS adds V58.63 (Long-term [current] use of antiplatelet/antithrombotic) for medications such as Plavix, Karl says. Also, add V58.64 (Long-term [current] use of nonsteroidal anti-inflammatories [NSAID]) for patients on non-steroidal anti-inflammatory drugs. And use V58.65 (Long-term [current] use of steroids) when patients use steroidal medications.

Remember that when patients take Coumadin, which is an anticoagulant, you will continue to use the old code, V58.61, Karl says.

For a complete list of new and invalid diagnosis codes, see "Quick Key: Cardiology-Related ICD-9 Changes You Don't Want to Miss."

For extensive information on the ICD-9 updating process, along with a detailed timeline in the summary report of the most recent meeting of the ICD-9-CM Coordination and Maintenance Committee, go to http://www.cms.hhs.gov/paymentsystems/icd9/icd040303.pdf.