Radiology Coding Alert

Documentation should highlight the extremity involved.

Some of the changes ICD-10 will bring in 2013 are all about pinpointing anatomic location. You'll find this to be the case with the I70.21- range for native artery atherosclerosis with intermittent claudication. Here's how the switch to ICD-10 will change your coding.

ICD-9-CM Code

• 440.21, Atherosclerosis of the extremities with intermittent claudication

ICD-10-CM Codes

• I70.211, Atherosclerosis of native arteries of extremities with intermittent claudication, right leg
• I70.212, Atherosclerosis of native arteries of extremities with intermittent claudication, left leg
• I70.213, Atherosclerosis of native arteries of extremities with intermittent claudication, bilateral legs
• I70.218, Atherosclerosis of native arteries of extremities with intermittent claudication, other extremity
• I70.219, Atherosclerosis of native arteries of extremities with intermittent claudication, unspecified extremity

Atherosclerosis refers to hardening and thickening of the arteries. Lack of blood to the muscles may cause claudication (pain or cramping). "Intermittent" indicates the pain comes and goes, typically resolving with rest. The reference to native arteries indicates a code applies to the patient's own arteries, rather than to bypass grafts that have been surgically inserted.

ICD-9 coding rules: ICD-9 offers a single code for extremity atherosclerosis with intermittent claudication: 440.21. For the 440.2x range, ICD-9 instructs you to use an additional code, if applicable, to identify chronic total occlusion of an extremity artery.

ICD-10 changes: ICD-10 expands your coding options by requiring you to use your code to indicate whether the patient's condition is in the right leg, left leg, both legs, or another extremity. If the physician doesn't specify which extremity is involved, you also have an "unspecified" code available. Like ICD-9, ICD-10 instructs you to use an additional code, if applicable, to identify chronic total occlusion of an extremity artery.

Documentation: For you to choose the most specific ICD- 9 code, your provider will need to be precise about which extremity is involved, including which side of the body the extremity is on. As a coder, you'll want to have that key information easily accessible in the chart.

Coder tips: Review the inclusion and excludes notes for the I70.- range and for the I70.2- range. You'll learn that just as with ICD-9 coding, you should look elsewhere if you need to report atherosclerosis of a bypass graft. You'll also learn that the I70 range has a lengthy "use additional code to identify" list:

• Exposure to environmental tobacco smoke (Z77.22) History of tobacco use (Z87.891)
• Occupational exposure to environmental tobacco smoke (Z57.31)
• Tobacco dependence (F17.-)
• Tobacco use (Z72.0).

Remember: When ICD-10 goes into effect on Oct. 1, 2013, 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.