Cardiology Coding Alert

Question: I code for echocardiography. Codes 396.3 and 396.8 are listed under the header "Chronic Rheumatic Heart Disease," but the actual code says, "multiple involvement of aortic and mitral valves, whether specified as rheumatic or not." This is a bit confusing. Is it correct to use this code for patients even with no mention of chronic rheumatic heart disease?

Answer: Yes. As you state, the "Includes" note under 396.x (Disease of mitral and aortic valves) says, "Includes: involvement of both mitral and aortic valves, whether specified as rheumatic or not." According to ICD-9 guidelines, the "includes" note is there "to further define, or give examples of, the content of the category."

Translation: All of the 396.x codes, including 396.3 (Mitral valve insufficiency and aortic valve insufficiency) and 396.8 (Multiple involvement of mitral and aortic valves), are appropriate for patients documented as having rheumatic heart disease and for patients whose charts show no documentation of rheumatic heart disease. Therefore, you should use the appropriate 396.x code instead of reporting 424.0 (Mitral valve disorders) and 424.1 (Aortic valve disorders) together.