Internal Medicine Coding Alert

Question: I heard at a conference that you shouldn't use 414.2 as a firstlisted diagnosis. Is this true?

Answer: When you have documentation of coronary atherosclerosis, you should report a code for that first, followed by 414.2 (Chronic total occlusion of coronary artery).

Reason: A note with 414.2 states, "Code first coronary atherosclerosis (414.00-414.07)."

ICD-9 official guidelines explain that "when a 'code first' note is present and an underlying condition is present the underlying condition should be sequenced first" (www.cdc.gov/nchs/icd/icd9cm_addenda_guidelines.htm).

But don't omit 414.2 just because it comes second. Indicating the patient has chronic total occlusion may help support the cardiologist's choice to perform more difficult treatments.