Cardiology Coding Alert

Learn two coding options you'll be throwing out come Oct. 1

You won't be slammed with tons of new diagnosis codes in 2008, but you still have to learn -- and adjust your claims to -- a series of new cardiology ICD-9 codes as of Oct. 1.  Preparing now could mean all the difference between reimbursement and a denial.

Good news: "Overall, these codes are helpful, and you'll be happy to have them added/clarified," says Jerome Williams Jr., MD, FACC, a cardiologist with Mid Carolina Cardiology in Charlotte, N.C.

Check Out These 2 New CTO Codes

First of all, you've got two new codes for chronic total occlusion (CTO).

What it is: A CTO occurs when a combination of thrombus and cholesterol plaque completely occludes an artery for more than 30 days. CTO arteries account for 20 percent to 30 percent of the documented coronary disease encountered in coronary catheterization labs. Cardiologists treat this condition in three ways: percutaneous intervention, coronary artery bypass grafting (CABG, 33510-33545), and medical management. 

New codes: As of Oct. 1, you'll use 414.2 (Chronic total occlusion of coronary artery) when the patient has a coronary artery 100 percent occluded for several months. Similarly, you'll use 440.4 (Chronic total occlusion of artery of the extremities) when a patient has 100 percent occlusion of an artery that supplies the arms or legs, Williams says.

Example: Suppose your cardiologist sees a patient with symptoms of angina and does a cardiac catheterization. From the results of the catheterization, he diagnoses 414.2. This code provides medical necessity for the physician to perform a CABG (33510, Coronary artery bypass, vein only; single coronary venous graft).

Keep in mind: You may not immediately see this change reflected in local coverage determinations (LCD). "These codes may not make it into your LCD policies for several months or longer," says Jim Collins, ACS-CA, CHCC, CPC, CEO of theCardiology Coalition in Matthews, N.C.

Energize Your Embolism Coding With 2 New Codes

Second, you'll have two new codes for septic embolisms.

What they are: Embolisms occur when an object (such as a clot or chunk of plaque) migrates from one part of the body through circulation and causes a blockage (or occlusion) of a blood vessel in another body area. A pulmonary embolism is a blockage of the pulmonary artery or one of its branches by an embolus.

When a patient has 415.12 (Septic pulmonary embolism), he has an infected embolus that has migrated to the lung. If the patient has 449 (Septic arterial embolism), this is an infected embolus that has migrated to any arterial bed, Williams says.

What to look for: "The arterial bed affected will determine the symptoms. The patient would have ischemia of that bed," Williams says. For instance, a septic embolism to the leg may manifest as leg pain from limb ischemia. Septic emboli to the lung would result in shortness of breath, and septic emboli to the brain would induce stroke symptoms.

Clear Up Cardiac Tamponade Claims

You may already have a code for cardiac tamponade (also known as "pericardial tamponade"), but you'll be using the new code as of Oct. 1.

Know what it means: Cardiac tamponade is a medical emergency condition in which fluid accumulates in the pericardium, the sac surrounding the heart. "This compression of the heart results in a decrease in cardiac output," Williams says. The result is ineffective pumping of blood, shock and often death. Your cardiologist will diagnose this condition clinically, typically with an echocardiogram, Collins says.

Right now: You should be using 423.9 (Unspecified disease of pericardium). But you'll have a more specific code for 2008, Collins say.

As of Oct. 1: You should report 423.3 (Cardiac tamponade).

Expand Your Family History V Codes

Finally, you'll be expanding your V code options for patients with family histories of cardiac events. "They should not be burdensome," Williams says.

Right now: If a patient has a family history of cardiovascular disease or even sudden cardiac death, your only option is V17.4 (Family history of other cardiovascular diseases).

As of Oct. 1: Code V17.4 will become invalid. Instead, you'll have three other codes at your disposal:

• V17.40 -- Family history of cardiovascular diseases, unspecified

• V17.41 -- Family history of sudden cardiac death (SCD)

• V17.49 -- Family history of other cardiovascular diseases.

Remember, according to CPT, family history includes a review of health-related events in the patient's family, such as:

• health status or cause of death of parents, siblings and children

• specific diseases related to problems identified in the chief complaint or history of the present illness, and/or system review

• diseases of family members that may be hereditary or place the patient at risk.