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Chapter 7. Cardiovascular System
The increased specificity of ICD-10-CM makes it imperative that physicians
document more detailed information and that coders are able to determine from
documentation the code or codes appropriate for the patient’s condition.
Valvular Disorders
Acute rheumatic fever, a complication of strep pharyngitis in children, results in
various cardiac conditions in more than a third of patients affected. Depending
on the extent of heart inflammation involved, patients with the acute form of
the disease may develop heart failure, pericarditis, myocarditis, and endocarditis,
which is manifested as insufficiency of the mitral (65 to 70 percent of cases) and
aortic valves (25 percent of cases).

DEFINITIONS
pericarditis. Inflammation affecting
the pericardium.
Figure 7.11: Valvular Function
Chronic disease may result in arrhythmias, ventricular dysfunction, and dilation
of the atria. In adults, acute rheumatic fever is the most common cause of mitral
valve stenosis and the leading cause for valvular replacement surgery. Although
the mitral valve is most commonly affected, the aortic and tricuspid valves may
also be involved.
Chronic manifestations due to protracted disease and continued valve deformity
occur in an estimated 9 to 39 percent of adults with previous rheumatic heart
disease. Two to 10 years after an acute episode of rheumatic fever, the valve
apparatus may fuse, with resulting stenosis or stenosis with insufficiency. Each
recurrent episode can extend the valvular damage.
For acute rheumatic heart conditions, there is a one-to-one mapping of the
appropriate ICD-9-CM code to the appropriate ICD-10-CM code. For
instance, ICD-9-CM code 391.0 for acute rheumatic pericarditis directly
correlates to code IØ1.1 in ICD-10-CM. This is also true for some valvular
diseases resulting from rheumatic fever. Although ICD-9-CM does classify some
conditions as rheumatic in nature, ICD-10-CM has distinguished, in large part,
specific valvular diseases caused by rheumatic fever versus those not related to
the disease, as well as the specific valve involved as shown in the following table.
This differentiation does not always result in additional ICD-10-CM codes, as
demonstrated by ICD-9-CM codes 396.0 through 396.8, which map to
ICD-10-CM code IØ8.Ø.
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Comprehensive Anatomy and Physiology for ICD-10-CM and ICD-10-PCS Coding
Coding for Diseases of the Heart Valves
ICD-9-CM
ICD-10-CM
Rheumatic
394.0
Mitral stenosis
I05.0
Rheumatic mitral stenosis
394.2
Mitral stenosis with
insufficiency
I05.2
Rheumatic mitral stenosis with insufficiency
394.9
Other and unspecified mitral
valve diseases
I05.8
I05.9
Other rheumatic mitral valve diseases
Rheumatic mitral valve disease, unspecified
396.0
Mitral valve stenosis and aortic I08.0
valve stenosis
Rheumatic disorders of both mitral and aortic
valves
396.1
Mitral valve stenosis and aortic I08.0
valve insufficiency
Mitral valve insufficiency and
aortic valve stenosis
Mitral valve insufficiency and
aortic valve insufficiency
Rheumatic disorders of both mitral and aortic
valves
397.0
Diseases of tricuspid valve
I07.0
I07.1
I07.2
I07.8
I07.9
Rheumatic tricuspid stenosis
Rheumatic tricuspid insufficiency
Rheumatic tricuspid stenosis and insufficiency
Other rheumatic tricuspid valve diseases
Rheumatic tricuspid valve disease, unspecified
397.1
Rheumatic diseases of
pulmonary valve
I09.89
Other specified rheumatic heart diseases
397.9
Rheumatic diseases
endocardium valve
unspecified
I08.1
Rheumatic disorders of both mitral and
tricuspid valves
Rheumatic disorders of both aortic and
tricuspid valves
Combined rheumatic disorders of mitral,
aortic, and tricuspid valves
Other rheumatic multiple valve diseases
Rheumatic multiple valve disease, unspecified
Rheumatic diseases of endocardium, valve
unspecified
396.2
396.3
I08.2
I08.3
I08.8
I08.9
I09.1
There are many differences between the ICD-9-CM and ICD-10-CM
terminology used for valvular disorders. Key differences can be as simple as a
“disorder” code in ICD-9-CM becoming more specific in ICD-10-CM;
however, there are some important terms to be aware of.

DEFINITIONS
insufficiency. Inadequate closure of
the valve, allowing abnormal
backward blood flow.
regurgitation. Abnormal backward
flow.
stenosis. Narrowing or constriction
of a passage.
Insufficiency is, in general, the inability to perform a function adequately or to
the level necessary for the human body. When using the term with regard to
valve function, it typically means the valve isn’t functioning as well as it should
be, allowing blood to flow back into the chamber inappropriately.
Prolapse, specifically mitral valve prolapse, occurs when the cusps of the mitral
valve protrude into the left atrium during ventricular systole. It is sometimes
referred to as mitral valve prolapse syndrome.
Stenosis means narrowing or contracted. Regarding the valves, it describes a
condition in which there has been a narrowing or a stricture caused by a
multitude of factors, such as calcification or a congenital malformation.
Understanding these three terms helps when reporting valve disorders in
ICD-10-CM. It is not known how payers will handle unspecified codes under
the ICD-10-CM code set, so it is important to always code to the highest level
of specificity. This may mean querying the provider for additional information.
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Comprehensive Anatomy and Physiology for ICD-10-CM and ICD-10-PCS Coding

DEFINITIONS
aphasia. Partial or total loss of the
ability to comprehend language or
communicate through speaking, the
written word, or sign language.
Aphasia may result from stroke,
injury, Alzheimer's disease, or other
disorder. Common types of aphasia
include expressive, receptive,
anomic, global, and conduction.
apraxia. Impaired sequencing of
motor skills. Apraxia can be used to
describe a variety of symptoms, from
an awkward gait to anomalous
speech.
ataxia. Defect in muscular
coordination, seen especially when
voluntary muscular movements are
attempted.
cognitive. Having to do with being
aware by drawing from knowledge,
such as judgment, reason,
perception, and memory.
cortical. Pertaining to the cortex,
which is the outer portion of an
organ. In the brain it refers to the
outer part of the cerebrum.
dysarthria. Difficulty pronouncing
words.
dysphagia. Difficulty and pain upon
swallowing. Common causes of
dysphagia are esophagitis, Barrett's
esophagus, or late effect of a stroke.
hemianopsia. Loss of partial vision
or complete blindness in half of the
visual field of one (unilateral
hemianopsia) or both (bilateral
hemianopsia) eyes.
hemiplegia. Paralysis of one side of
the body.
monoplegia. Loss or impairment of
motor function in one arm or one
leg.
subcortical. Pertaining to the part of
the brain below the cebral cortex.
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Intracerebral hemorrhage accounts for 10 to 15 percent of all strokes. This type
of stroke is associated with a much higher rate of mortality than that of the more
common acute ischemic stroke, caused by thrombosis or embolism.
Intracerebral hemorrhages (nontraumatic) are classified to category 430 in
ICD-9-CM, and traumatic hemorrhages are classified to category 851,
regardless of where the bleeding occurs in the brain. ICD-10-CM classifies
intracerebral hemorrhages according to whether the bleed was traumatic or
nontraumatic, but also designates the specific part of the brain in which the
bleed occurred for nontraumatic bleeds.
Coding for Intracerebral Hemorrhage
ICD-9-CM
ICD-10-CM
431
I61.0
Intracerebral hemorrhage
I61.1
I61.2
I61.3
I61.4
I61.5
I61.6
I61.8
I61.9
Nontraumatic intracerebral hemorrhage in
hemisphere, subcortical
Nontraumatic intracerebral hemorrhage in
hemisphere, cortical
Nontraumatic intracerebral hemorrhage in
hemisphere, unspecified
Nontraumatic intracerebral hemorrhage in
brain stem
Nontraumatic intracerebral hemorrhage in
cerebellum
Nontraumatic intracerebral hemorrhage,
intraventricular
Nontraumatic intracerebral hemorrhage,
multiple localized
Other nontraumatic intracerebral hemorrhage
Nontraumatic intracerebral hemorrhage,
unspecified
Residual Effects of Cerebrovascular Disease
When a brain injury occurs due to a stroke or other type of cerebrovascular
disease or due to a traumatic injury to the brain, residual effects can occur
according to the severity and the site of the brain injury. This includes paralysis;
speech and language problems, such as aphasia, dysarthria, and dysphasia; and
cognitive defects. For both coding classification systems, these residual
neurological deficits are reported in addition to the underlying brain injury code
regardless of when the deficit occurs. Once again, ICD-10-CM classifies these
conditions with greater specificity, including hemiplegia and monoplegia for
which ICD-10-CM indicates if the left or right side or limb is dominant.
ICD-9-CM simply refers to the dominant side, with no distinction between
right and left. Speech deficits are also classified in much more detail in
ICD-10-CM, specifying the underlying cause of the condition, as indicated in
the following table.
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Comprehensive Anatomy and Physiology for ICD-10-CM and ICD-10-PCS Coding
Central Nervous System (0)
Procedures involving the central nervous system can cover a variety of areas and
a number of different types of procedures, such as nerve transfers and mapping
procedures. A compiled table for body system character 0 Central Nervous
System shows all of the valid characters for that system under ICD-10-PCS.
Operation–Character 3
1 Bypass
Body Part–Character 4
0 Brain
Approach–Character 5
Device–Character 6
Qualifier–Character 7
0 Open
0 Drainage Device
0 Nasopharynx
2 Monitoring Device
1 Mastoid Sinus
2 Change
1 Cerebral Meninges
3 Percutaneous
5 Destruction
2 Dura Mater
4 Percutaneous Endoscopic 3 Infusion Device
2 Atrium
8 Division
3 Epidural Space
X External
7 Autologous Tissue
Substitute
3 Blood Vessel
9 Drainage
4 Subdural Space
J Synthetic Substitute
4 Pleural Cavity
B Excision
5 Subarachnoid Space
K Nonautologous Tissue
Substitute
5 Intestine
C Extirpation
6 Cerebral Ventricle
M Electrode
6 Peritoneal Cavity
D Extraction
7 Cerebral Hemisphere
Y Other Device
7 Urinary Tract
F Fragmentation
8 Basal Ganglia
Z No Device
8 Bone Marrow
H Insertion
9 Thalamus
9 Fallopian Tube
J Inspection
A Hypothalamus
B Cerebral Cisterns
K Map
B Pons
F Olfactory Nerve
N Release
C Cerebellum
G Optic Nerve
P Removal
D Medulla Oblongata
H Oculomotor Nerve
Q Repair
E Cranial Nerve
J Trochlear Nerve
S Reposition
F Olfactory Nerve
K Trigeminal Nerve
T Resection
G Optic Nerve
L Abducens Nerve
U Supplement
H Oculomotor Nerve
M Facial Nerve
W Revision
J Trochlear Nerve
N Acoustic Nerve
X Transfer
K Trigeminal Nerve
P Glossopharyngeal Nerve
L Abducens Nerve
Q Vagus Nerve
M Facial Nerve
R Accessory Nerve
N Acoustic Nerve
S Hypoglossal Nerve
P Glossopharyngeal Nerve
X Diagnostic
Q Vagus Nerve
Z No Qualifier
R Accessory Nerve
S Hypoglossal Nerve
T Spinal Meninges
U Spinal Canal
V Spinal Cord
W Cervical Spinal Cord
X Thoracic Spinal Cord
Y Lumbar Spinal Cord
This table provides a great basis from which to study important terminology
concerning the central nervous system, as well as terms used throughout
ICD-10-PCS in general.
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Chapter 14. Anatomy and Physiology and the ICD-10-PCS Code Set: Nervous and Circulatory Systems
Root Operation — Character 3
The root operation character is one of the first key decisions required in the
ICD-10-PCS coding process. Understanding the meanings of the various root
operations is vital to code selection. Each body system has its own list of
appropriate root operations. The characters are consistent across all body
systems in the medical and surgical section of ICD-10-PCS, but not all root
operation characters are used in all tables. Refer to Appendix C for the full
definition of all root operations in ICD-10-PCS. The root operations used in
the central nervous system table are as follows:
Root Operation
Character Value
Root Operation
Character Value
Bypass
1
Inspection
J
Change
2
Map
K
Destruction
5
Release
N
Division
8
Removal
P
Drainage
9
Repair
Q
Excision
B
Reposition
S
Extirpation
C
Resection
T
Extraction
D
Supplement
U
Fragmentation
F
Revision
W
Insertion
H
Transfer
X
The terms used in ICD-10-PCS may not be the terms used in documentation
by the providers. A good example of this is the root operation extirpation, a term
not familiar to many coders. Extirpation is the removal of solid matter from a
body part, oftentimes a tubular body part, although that is not required. This
term may not be found in the operative report. However, knowledge and
understanding of the PCS definition of this term is required for accuracy in
assignment of the most appropriate ICD-10-PCS code.
Body Part — Character 4
The body part characters in ICD-10-PCS detail the specific site where the
procedure was performed. Again, the physician may use different terminology
than is used in the table, so it is vital to understand not only the term as given in
the table but also associated terms.
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Comprehensive Anatomy and Physiology for ICD-10-CM and ICD-10-PCS Coding
Figure 14.1: Brain Sections
Thalamus 9
Choroid plexus 6
Cerebrum 0
Hypothalamus A
Basal ganglia 8
Third ventricle 6
Cerebral
aqueduct 6
Pons
B
Subarachnoid
space 5
Dura mater 2
Medulla oblongata D
Cerebellum C
Choroid plexus 6
Fourth ventricle 6
Spinal cord V
Character Value – 0, Brain
Associated Terms: Cerebrum, Corpus callosum, Encephalon
The cerebrum is the large uppermost section of the brain, which is divided into
two hemispheres. The corpus callosum is the band of nerve fibers that joins the
two cerebral hemispheres together. Encephalon is a term that is used to refer to
all of the contents of the cranium, such as the cerebrum, the cerebellum, and the
other structures of the brain.
Character Value – 1, Cerebral Meninges
Associated Terms: Arachnoid mater, Leptomeninges, Pia mater
The meninges are the membranes that enclose the brain and the spinal cord, and
the cerebral meninges are those that specifically enclose the cerebrum. The
arachnoid membrane or mater/sheath lies between the dura mater and the pia
mater to help protect the brain. The pia mater is the inner most layer of
membrane helping to protect the brain. This membrane layer is rich in blood
vessels to help supply the nervous tissue. The leptomeninges is a term used to
describe both the pia mater and the arachnoid membrane in combination with
one another.
Character Value — 2, Dura Mater
Associated Terms: Cranial dura mater, denticulate ligament, diaphragma sellae,
falx cerebri, spinal dura mater, tentorium cerebelli
The dura mater is the outermost membrane of those that enclose the brain and
spinal cord. The denticulate ligaments are “tooth-like” portions of ligament that
attach the pia mater to the dura mater and arachnoid membranes, and are
known to give some stability to the spinal cord with the vertebral column.
Several of these terms are different types of dura mater. The diaphragma sellae is
the portion of the dura mater that creates a partition between the pituitary gland
and the brain above. The falx cerebri is a sickle-shaped fold of the dura mater
that extends into the fissure between the two hemispheres of the cerebrum. The
tentorium cerebelli is a horizontal projection of the meningeal dura mater that
separates the cerebellum in the posterior cranial fossa from the posterior portion
of the cerebral hemispheres.
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