Radiology Coding Alert

Tip: 434.10 isn't the only ICD-9 code that crosses to this range.

Did you hear the news? On April 9, Department of Health and Human Services (HHS) Secretary Kathleen Sebelius announced a proposed rule that includes a possible new ICD-10 implementation date: Oct. 1, 2014.

This information about the proposed one-year delay is in the April 9 press release, "New Health Care Law Provisions Cut Red Tape, Save Up to $4.6 Billion," at www.cms.gov/apps/media/press_releases.asp. Make the most of the delay by ensuring your preparations are on target. Be sure to focus on codes with increased specificity requirements, like the cerebral embolism codes described below.

Cerebral embolism refers to occlusion or obstruction of a cerebral vessel by a blood clot or foreign material.

ICD-9-CM Code

• 434.10, Cerebral embolism without cerebral infarction

ICD-10-CM Code Range

• I66.--, Occlusion and stenosis of cerebral arteries, not resulting in cerebral infarction

ICD-9 coding rules: In ICD-9, there is a single code for cerebral embolism without cerebral infarction. You report 434.10 for embolism in all territories of cerebral blood supply.

ICD-10 changes: ICD-10 expands your code choices significantly with additional options based on the artery involved and the laterality of the vessel. All of the codes begin with I66. You then determine the artery or arteries involved:

• I66.0-, middle cerebral
• I66.1-, anterior cerebral
• I66.2-, posterior cerebral.

You then determine the fifth character based on laterality:

• 1, right
• 2, left
• 3, bilateral
• 9, unspecified.

For instance, to report "occlusion and stenosis of bilateral middle cerebral arteries," you should use I66.03.

ICD-10 also includes an option for cerebellar arteries (I66.3, Occlusion and stenosis of cerebellar arteries). If the physician doesn't specify the artery, use I66.9 (Occlusion and stenosis of unspecified cerebral artery).

Documentation: In addition to differing based on the artery involved, the codes are specific for right, left, and bilateral involvement. "This is the true specificity provided by ICD-10, and providers may need guidance in improving their documentation to include these details so they can be accurately reported," says Marvel Hammer, RN, CPC, CCS-P, PCS, ACS-PM, CHCO, owner of MJH Consulting in Denver, Colo.

Coder tips: The I66.-- codes don't just map to 434.10. They also cross to 434.00 (Cerebral thrombosis without cerebral infarction) and 434.90 (Cerebral artery occlusion unspecified without cerebral infarction).

Remember: When ICD-10-CM goes into effect, you should apply the code set and official guidelines in effect for the date of service reported. Learn more at www.cms.gov/ICD10/ and www.cdc.gov/nchs/icd/icd10cm.htm#10update.