Primary Care Coding Alert

New codes, notes, in store for Chapter 9.

The 2020 edition of ICD-10-CM features some big changes in the Diseases of the Circulatory System (I00-I99) chapter. That means coding for your patients with heart conditions, phlebitis, embolism, and thrombosis just got a little more complicated.

But don’t worry. Read on, and you’ll find all the significant changes that might well impact your coding beginning October 1, 2019. And we’ve added a handy guide to the medical terminology you might need to help you understand what each code represents.

New Embolism, AFib Codes Help You Get More Specific …

To begin with, you will have two new pulmonary embolism codes — I26.93 (Single subsegmental pulmonary embolism without acute cor pulmonale) and I26.94 (Multiple subsegmental pulmonary emboli without acute cor pulmonale).

“The change is a result of a proposal put forward by the American College of Chest Physicians [ACCP], who pointed out that, as the optimal treatment for these conditions is different from other pulmonary emboli, and as these kind of emboli could only previously be coded to an ‘other’ code — I26.99 [Other pulmonary embolism without acute cor pulmonale] — the conditions needed their own separate codes,” says Melanie Witt, RN, CPC, MA, an independent coding expert based in Guadalupita, New Mexico.

There is a similar rationale behind the addition of four new atrial fibrillation (Afib) codes:

• I48.11 (Longstanding persistent atrial fibrillation)
• I48.19 (Other persistent atrial fibrillation)
• I48.20 (Chronic atrial fibrillation, unspecified)
• I48.21 (Permanent atrial fibrillation).

“The previous codes only allowed you to report persistent or chronic atrial fibrillation,” Witt notes. “Now, ICD-10-CM has expanded the persistent Afib [I48.1] and chronic Afib [I48.2] codes to reflect the different characteristics of, and treatments for, the longstanding persistent and permanent forms of the condition,” Witt adds.

… While Vein Disease Codes Get New Anatomic Sites …

Perhaps the biggest change to this section is the addition of a huge number of new phlebitis and thrombophlebitis (I80) and other venous embolism and thrombosis (I82) codes. The additions will now allow you to pinpoint conditions in the peroneal and calf muscle veins by using

• I80.24- (Phlebitis and thrombophlebitis of peroneal vein)
• I80.25- (Phlebitis and thrombophlebitis of calf muscular vein)
• I82.45- (Acute embolism and thrombosis of peroneal vein)
• I82.46- (Acute embolism and thrombosis of calf muscular vein)
• I82.55- (Chronic embolism and thrombosis of peroneal vein)
• I82.56- (Chronic embolism and thrombosis of calf muscular vein).

The codes are a welcome addition, not only because they supply some much-needed specificity. “Until now, coders could only report such conditions with other and unspecified codes, which could specify laterality, but not specify location as distal — calf — or proximal — thigh.” says Sheri Poe Bernard, CPC, CRC, CDEO, CCS-P, author of the AMA book, Risk Adjustment Documentation and Coding.

Adding this missing proximal/distal piece of information may also enable better treatment options for your patients. “According to the Agency for Healthcare Research and Quality, which requested the new codes, capturing deep vein thrombosis [DVT] location more precisely may aid researchers in targeting management options for the different types of DVTs, as researchers believe that DVTs in the thigh are more risky than DVTs in the calf,” Bernard goes on.

As with all the other codes in the Diseases of veins, lymphatic vessels and lymph nodes, not elsewhere classified (I80-I89) group, you will be able to add a sixth digit to specify right (1), left (2), bilateral (3), or unspecified (9). And, “you should note the changes in the inclusion terms to both the new and existing codes, which give explicit instructions to code use and add still more clarity to the ICD-10-CM,” Bernard adds.

… and MI Type 2 Guidelines Receive a Tweak

Finally, beginning October 1, there’s a small but very significant change to the myocardial infarction (MI) type 2 code instructions. ICD-10-CM also revises the Code Also instruction note that accompanies I21.A1 (Myocardial infarction type 2) to read that you must Code First, rather than Code Also, any underlying causes for the MI. Additionally, CMS has removed heart failure (I50.-) and renal failure (N17.0-N19) from the list of examples of underlying causes that you should Code First.

Quick Guide to Circulatory Disease Terminology

Atrial fibrillation: An irregular and often rapid heartbeat.
Embolism: A sudden blockage of an artery caused by foreign material or a clot.
Pulmonary embolism: Blockage of the main artery into the lungs.
Subsegmental: Less than the whole segment.
Acute/Chronic cor pulmonale: Overload of the right ventricle usually resulting from acute/chronic pulmonary embolism.
Myocardial infarction (MI): Heart attack caused by a blood clot blocking a coronary artery.
Phlebitis: Inflammation of a vein.
Thrombosis: Formation of a thrombus, or blood clot.
Thrombophlebitis: Phlebitis accompanied by the formation of a thrombus.