ICD 10 Coding Alert

Question: Our patient has a principal diagnosis of congestive heart failure (CHF). She also has coronary artery disease (CAD), hypertension (HTN) and emphysema. She is using oxygen intermittently. How should we code for her?

Delaware Subscriber

Answer: List the following diagnoses for this patient:

• 428.0 (Congestive heart failure, unspecified);
• 492.8 (Other emphysema);
• 401.9 (Unspecified Essential hypertension);
• 414.00 (Coronary atherosclerosis; of unspecified type of vessel, native or graft); and
• V46.2 (Dependence on supplemental oxygen).

Your patient’s principal diagnosis is CHF, you don’t have additional details about this diagnosis, so 428.0 for CHF unspecified is your first-listed code.

You’ll need to report the patient’s other co-morbidities next. Sequencing for these conditions is discretionary, but make certain that the plan of care discusses the impact your patient’s emphysema, hypertension, and CAD will have on her care.

Finally, list a status V code to indicate that the patient is receiving supplemental oxygen.

In ICD-10, you would list the following codes for this patient:

• I50.9 (Heart failure, unspecified);
• J43.9 (Emphysema, unspecified);
• I10 (Essential [primary] hypertension);
• I25.1 (Atherosclerotic heart disease of native coronary artery); and
• Z99.81 (Dependence on supplemental oxygen).

In ICD-10, at the emphysema code and the CAD code, you’ll find a note to “Use additional code to identify” exposure to tobacco smoke or use. Be sure to include this information when appropriate. You can sequence these codes, such as Z72.0 (Tobacco  use) further down in your list.

Just as in ICD-9, you can’t assume the patient’s heart problems are due to his hypertension, so you cannot list a hypertensive heart disease code for this patient.

To find the supplemental oxygen code in ICD-10, look under “dependence” in the alphabetic index.