Cardiology Coding Alert

Question: When a cath is done and the patient has CAD in a native vessel that was never bypassed and also has CAD in a bypass graft, we get an edit error when we try to submit I25.10 and I25.810. The error says these two codes cannot be used together. Under I25.81-, the Excludes1 note states, “atherosclerotic heart disease of native coronary artery without angina pectoris (I25.10).” It seems that as diagnostic findings, they would both need to be used. But, if they can’t be used together, which diagnosis takes precedence?

Tennessee Subscriber

Answer: “If the two conditions are not related to one another, it is permissible to report both codes despite the presence of an Excludes1 note.” That’s according to recent advice approved by AHIMA, AHA, CMS, and NCHS, slated for publication in the 4^th Quarter 2015 issue of Coding Clinic for ICD-10-CM and ICD-10-PCS. You can see the announcement at www.cdc.gov/nchs/data/icd/Interim_advice_updated_final.pdf.

Example: According to the statement, one example involves I60-I69 (Cerebrovascular Diseases), which “has an Excludes1 note for traumatic intracranial hemorrhage (S06.-). Codes in I60-I69 should not be used for a diagnosis of traumatic intracranial hemorrhage. However, if the patient has both a current traumatic intracranial hemorrhage and sequela from a previous stroke, then it would be appropriate to assign both a code from S06.- and I69.-.”

Experts advise making the decision on a case by case basis and escalating the decision to your coding leads or management team if you can’t decide if the diagnoses are unrelated.

Final thought: The code for a cold provides evidence that hard edits that forbid reporting codes in Excludes1 notes together with the main code can cause problems. The code for the common cold, J00 (Acute nasopharyngitis [common cold]), lists conditions coded to J31.0 (Chronic rhinitis) under BOTH Excludes1 and Excludes2. Rhinitis NOS, coded as J31.0, is under the Excludes1 note, and J31.0 for chronic rhinitis is under the Excludes2 note. So you should be able to report J31.0 with J00 in some cases (based on the Excludes2 note), but a hard edit based on the Excludes1 note would prevent it.