ICD 10 Coding Alert

Add new codes I63.81 and I63.89 to your knowledge base.

The field of cardiology may not have been hugely affected by the 2019 ICD-10 revisions, but that’s no reason to ignore them, according to Christina Neighbors, MA, CPC, CCC, Coding Quality Auditor for Conifer Health Solutions, Coding Quality & Education Department, and member of AAPC’s Certified Cardiology Coder steering committee.

So, we’ve reviewed the most significant changes that are bound to impact your cerebral infarction and cerebrovascular reporting come Oct. 1.

See These Cerebral Infarction Additions and Revisions

Additions:  Category I63 (Cerebral infarction) will add the following new codes:

• I63.81 — Other cerebral infarction due to occlusion or stenosis of small artery. This code will also include lacunar infarction.
• I63.89 — Other cerebral infarction.

Don’t miss: An instructional note under category I63 tells you to report an additional code, if applicable, to identify status post administration of tPA (rtPA) in a different facility with the last 24 hours prior to the patient’s admission to the current facility (Z92.82).

Also, if applicable, you should report an additional code to indicate the patient’s National Institutes of Health Stroke Scale (NIHSS) score (R29.7-).

Revisions: Along with the additions, you’ll also see changes to I63.219 (Cerebral infarction due to unspecified occlusion or stenosis of unspecified vertebral artery) and I63.239 (… unspecified carotid artery). In both descriptors, the current word “arteries” has changed to “artery.”

Additionally, the following code descriptors have seen a slight change (emphasis added):

• I63.333 — Cerebral infarction due to thrombosis of bilateral posterior cerebral arteries
• I63.343 — Cerebral infarction due to thrombosis of bilateral cerebellar arteries.

Notice that that word “due” has been added to the code descriptors.

Highlight New Subcategory Under Category I67

Category I67 (Other cerebrovascular diseases) will add the new subcategory I67.85- (Hereditary cerebrovascular diseases) to your coding arsenal. Under that subcategory, you will find the following new codes.

• I67.850 — Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy. This diagnosis will also include CADASIL.
• I67.858 — Other hereditary cerebrovascular disease.

Don’t miss: Under I67.850 (Other cerebrovascular diseases) there is a new “code also” note that instructs you to also report any associated diagnoses such as epilepsy and recurrent seizures (G40.-); cerebral infarction (I63.-); and vascular dementia (F01.-).

Take Note of These Miscellaneous Revisions

Revisions: Some of the revisions are very minor and easy to miss. For example, the code descriptor for I22.8 (Subsequent posterior (true) transmural (Q wave) myocardial infarction (acute)) will change to (Subsequent posterior (true) transmural (Q wave) myocardial infarction (acute)). As you may observe, the only change here is the addition of a space between “true” and “transmural.”

Coding note revisions: Make sure you also carefully look at revisions to any coding notes. For example, for categories I60 (Nontraumatic subarachnoid hemorrhage) through I69 (Sequelae of cerebrovascular disease), there is a slight change to the note “use additional code to identify the presence of hypertension (I10, Essential primary hypertension) through I15, Secondary hypertension).” The revised note adds I16 (Hypertensive crisis) so now the range is I10 through I16.

Revisions: Once again, don’t blink or you will miss this minor change in an Excludes1 note for I77.6- (Arteritis, unspecified).

In the Excludes1 note, “M31.5., M31.6” will be revised to “M31.5, M31.6”. As you can see, ICD-10 2019 deletes the period between the “5” and the comma.