Practice Management Alert

Question: Our cardiology practice is having trouble crosswalking “abnormal chest sounds” from ICD-9 to ICD-10. Are we missing some detail in the ICD-10 manual?

New York Subscriber

Answer: Despite ICD-10’s increased specificity in some situations, the new diagnosis coding systems actually combines “other specified” circulatory and respiratory symptoms into a single code. Use this basic crosswalk for the following cardiovascular symptoms:

ICD-9-CM Codes

• 785.9, Other symptoms involving cardiovascular system
• 786.7, Abnormal chest sounds

ICD-10-CM Code

• R09.89, Other specified symptoms and signs involving the circulatory and respiratory systems

ICD-9 coding rules: Notes with cardiovascular symptom code 785.9 let you know it was appropriate for bruit (arterial) and weak pulse, but the code excluded heart failure NOS (428.9).

Abnormal chest sound code 786.7 excluded wheezing (786.07), but it was appropriate for:

• Abnormal percussion, chest
• Friction sounds, chest
• Rales
• Tympany, chest.

ICD-10 changes: Just as ICD-10 groups both ICD-9 codes into single code R09.89, ICD-10 also combines the ICD-9 lists of conditions the code is appropriate for. ICD-10 also adds feeling of foreign body in throat and choking sensation to the list. The note with R09.89 lists these conditions:

• Bruit (arterial)
• Abnormal chest percussion
• Feeling of foreign body in throat
• Friction sounds in chest
• Chest tympany
• Choking sensation
• Rales
• Weak pulse.

ICD-10 features an Excludes2 note for foreign body in throat (T17.2-) and wheezing (R06.2). Unlike ICD-9, ICD-10 doesn’t exclude heart failure NOS from the code. But you should be aware that the appropriate code for heart failure NOS is I50.9 (Heart failure, unspecified).

Documentation: The cardiologist’s documentation shouldn’t need to change between ICD-9 and ICD-10 to assist with supporting this code, but she should continue to be as specific as possible in documenting the patient’s symptoms so you can be sure you’ve chosen the most appropriate code for the case.

Tips: Code R09.89 applies to “other specified symptoms,” which means it is only appropriate when the provider documents a specific symptom and ICD-10 does not provide a more appropriate code for that symptom. Keep in mind that the code also may be appropriate for conditions not named in the bulleted list above.