Check for the specific problem before using these 996.71-996.72 replacements.
If you have a patient present with a pacemaker complication after ICD-10 is implemented, you’ll have to sift through eight different codes to find the best match for his case. Be sure your practice has a plan to capture the complication and encounter details the new codes will require.
The diagnosis: The codes below apply to non-mechanical complications of heart valve prostheses or other cardiac devices, implants, or grafts, such as a pacemaker, implantable defibrillator, or bypass graft. Complications may include embolism, fibrosis, hemorrhage, pain, stenosis, or thrombosis due to the device’s presence.
ICD-9-CM Codes:
ICD-10-CM Codes:
The appropriate 7th character is to be added to each code from category T82:
ICD-9 coding rules: ICD-9 offers two coding options. One (996.71) is specific to heart valve prosthesis complications. The other (996.72) applies to other cardiac devices, implants, and grafts specified in the documentation. The various non-mechanical complications that occur all fall under those broad codes. One important exception is coronary graft occlusion due to atherosclerosis, which you should instead code from the 414.0x range (Coronary atherosclerosis).
ICD-10 changes: ICD-10 makes use of seven characters to add specificity to each code. The new codeset will divide your options based on the specific type of complication. You also will need to add a seventh character specifying the encounter type (initial, subsequent, sequela). Like ICD-9, ICD-10 codes coronary graft atherosclerosis under separate ranges, which differ based on documentation of angina: I25.7- (Atherosclerosis of coronary artery bypass graft[s] and coronary artery of transplanted heart with angina pectoris) and I25.81- (Atherosclerosis of other coronary vessels without angina pectoris).
Documentation: To choose the most appropriate ICD-10 code, you’ll need documentation that the complication is due to a cardiac prosthetic device, implant, or graft. You’ll need to know whether the complication is an embolism, fibrosis, hemorrhage, pain, stenosis, thrombosis, or something else. Your physician should be documenting this information already, so you’ll just want to be sure the information is easily accessible so you may code efficiently. Take extra care to be sure you can easily distinguish whether the encounter is initial, subsequent, or sequela.
Coder tips: Unspecified complication code T82.9XX- includes “XX” as placeholders in spaces five and six to allow you to apply the seventh character as instructed.
ICD-10 Official Guidelines explain proper use of the seventh characters which specify the encounter:
ICD-10-CM guidelines are available at www.cdc.gov/nchs/icd/icd10cm.htm.