Wiki 397.0 or 424.2

[MandyFlagg]

Quick question,

I was asked a question regarding a confusing answer on the CCC practice test. As a former coding instructor and a current auditor/educator, I have used the ICD-9 book and I think I have answered it; however, the coder is still in disagreement and I can also see her point.

The diagnosis that need to be coded are:
Mild Aortic Stenosis
Mild MR and TR
Diastolic Dysfunction

Coder coded: 396.8, 424.2, and 429.9
Correct answer states: 396.8, 397.0, 429.9

When I look at this 397.0 falls under Rheumatic (no mention of this in note) however the code description states:
Diseases of the tricuspid valve - Tricuspid (valve)(rheumatic): disease, insufficiency, obstruction, regurgitation, stenosis
The definition under this states: Malfunction of the valve between right atrium and right ventricle; due to rheumatic heart diease.

Now 424.2 states Tricuspid valve disorders, specified as nonrheumatic - Tricuspid valve: incompetence, insufficiency, regurgitation, stenosis of specified cause, except rheumatic
The EXCLUDES notes state excludes: rheumatic or of unspecified cause (397.0)

So my take on the ICD-9 instructions would then take me back to using 397.0 due to not having a specified reason for the TR. I am just leary to use that beings that it falls under rheumatic?

Thoughts please?????

 

[mitchellde]

My take is that unless he specified it as non rheumatic then you code to the 397.0, there is a coding clinic noted for the 397.0 if you have access to coding clinics I would look this up.

 

[MandyFlagg]

I am not familiar with coding clinics? Can you give me a little more information?

 

[mitchellde]

In your code book just under the code number ( depending upon the publisher you use) there is an AHA reference. These are Coding clinics, it will tell you which quarter, year and page number. This is a paid service but most every hospital medical record dept subscribes. They are consider the last word for compliant coding.