Wiki ICD-10-CM Failure of a bioprosthetic heart valve

[AlaskanCoder]

We are having a discussion about the codes under category T82.22 for "Breakdown (mechanical) of biological heart valve graft". If patient has regurge or insufficiency due to failing bioprosthesis and is scheduled for replacement, is this an initial encounter (active treatment) or is it sequela? My coworker and I feel it is sequela. But, if that is the case, what justifies the use of A for the 7th character?

Thank you, in advance, we truly appreciate your comments.

Karen

 

[j.monday7814]

in this case it would be an initial encounter because this is the first time treating this complication. Sequela would apply if there was an issue arising from this particular complication, i.e. shortness of breath due to regurgitation from breakdown of the bioprosthesis.

personally, I've struggled with the decision to use the complication codes for regurgitation of a bioprosthesis because they are not designed to last forever and have normal breakdown after a decade or so. So if it is normal wear and tear then is it really a complication? ICD-9 was clear about not using the complication codes for normal wear and tear but I haven't found enough evidence in ICD-10 to make a definitive decision. I think if the valve was implanted less than a few years and is suddenly showing signs of regurgitation then that is a complication but if it was implanted more than 8 or 9 years ago then I don't know what the right answer is.