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Seminar #5 – Cardiovascular
Conditions
Deborah A. Balentine, M.Ed., RHIA, CCS-P
Kaplan University
Agenda
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Announcements
Coding for Cardiovascular Conditions, Part 1
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ICD-9-CM Coding for Diagnoses
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Hypertension (HTN)
Myocardial Infarction (MI)
Chronic Ischemic heart disease (CAD)
ICD-9-CM Coding for Procedures
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Coronary Bypass Procedures (CABG)
Cardiac Catheterizations
Percutaneous Transluminal Coronary Angioplasty (PTCA)
Coding for Cardiovascular Conditions
Hypertension
Hypertension is coded to Categories 401-405
4th digits identify the type of hypertension:
0 – Malignant
1 – Benign
9 – Unspecified
There is a special table for hypertension in the Alphabetical
Index to Diseases (Volume 2)
Coding for Cardiovascular Conditions
Code Structure – Combination Codes
If a patient has hypertension and certain other
conditions/manifestations combination codes are used to
describe the condition.
Terms or phases that imply a cause and effect include:
“Hypertensive”
“due to”
“caused by”
Relational terms like “and” and “with” do not always imply cause
and effect when coding for hypertension.
Coding for Cardiovascular Conditions
Hypertension and Heart Disease
If a patient has hypertension and heart disease and a causal
relationship is established between the two conditions, the
hypertension is coded to Category 402.x
4th digits identify the type of hypertension (i.e. benign,
malignant, etc.)
5th digits identify whether the patient has heart failure
If heart failure is present, then an additional code is needed to
describe the type of heart failure present.
Coding for Cardiovascular Conditions
Examples:
Benign hypertensive heart disease
402.10
Chronic hypertensive heart disease with chronic diastolic
heart failure
402.91 and 428.32
Congestive heart failure and benign hypertension
428.0 and 401.1
Coding for Cardiovascular Conditions
Hypertension and Chronic Kidney Disease (CKD)
If a patient has hypertension and chronic kidney disease you
can make the assumption that there is a causal relationship
between the two diseases.
Hypertension and Chronic Kidney Disease is coded to
Category 403.
4th digits identify the type of hypertension (i.e. benign,
malignant)
5th digits identify the stage of the Chronic Kidney Disease
And addition code is needed to identify the Chronic Kidney
Disease
Coding for Cardiovascular Conditions
Examples:
Malignant hypertension and Stage III CKD
403.00 and 585.3
Hypertensive chronic kidney disease
403.90 and 585.9
Hypertension and acute renal failure
401.9 and 584.9
Coding for Cardiovascular Conditions
Hypertension with CKD and Heart Disease
If a patient has hypertension, heart disease and CKD and a
causal relationship is established between the conditions,
the hypertension is coded to Category 404.x
4th digits identify the type of hypertension (i.e. benign,
malignant)
5th digits identify the presence of CKD and heart failure.
Additional codes are needed to identify the type of heart
failure and the stage of the CKD
Coding for Cardiovascular Conditions
Example:
Hypertensive heart disease. The patient also suffers from End
Stage Renal Disease
404.92 and 585.6
Malignant hypertensive heart disease with acute systolic heart
failure and Stage 5 CKD
404.03, 428.21 and 585.5
A patient is diagnosed with benign hypertension, congestive
heart failure and Stage II kidney disease
403.10, 428.0 and 585.2
Coding for Cardiovascular Conditions
Secondary Hypertension
Secondary hypertension is a condition in which the hypertension is
caused by an underlying condition as opposed to the
hypertension being the underlying cause in itself.
Secondary hypertension is coded to Category 405.x
4th digits identify the type of hypertension (i.e. benign, malignant,
etc.)
5th digits identify if the underlying cause is of a renovascular nature.
The underlying cause is reported as the primary/first-listed
diagnosis.
Coding for Cardiovascular Conditions
Secondary Hypertension
Hypertension due to renal artery stenosis
440.1 and 405.91
Malignant hypertension due to hypothyroidism
244.9 and 405.09
Coding for Cardiovascular Conditions
Myocardial Infarctions
Coded to Category 410.xx
4th Digits identify the wall involved in the infarction
5th digits identify the episode of care
Example: 410.01 – Myocardial infarction of the anterolateral
wall, initial episode of care
Example: 410.92 – Myocardial infarction, unspecified wall,
subsequent episode of care.
Coding for Cardiovascular Conditions
5th Digits for Myocardial infarctions:
0 – Episode of care unspecified; use this digit when the
source document does not contain enough information
to assign a more specific digit
1 – Initial episode of care; used for a newly diagnosed MI
until the patient has been discharged from acute care
2 – Subsequent episode of care; used to identify any
episode of care following the initial episode of care
Coding for Cardiovascular Conditions
Myocardial Infarctions (cont.)
412 – Old myocardial infarction, used when the MI is
described as healed and presenting with no symptoms (8
weeks from date of onset)
414.8 – Chronic MI, used when the MI is over 8 weeks old
and is still symptomatic.
Coding for Cardiovascular Conditions
Chronic Ischemic Heart Disease
Coded to Category 414.xx
4th digits identify the type of disease (arteriosclerosis vs.
aneurysm)
5th digits identify the vessels involved (native vs. autologous
vs. non autologous)
Examples:
CAD of native artery – 414.01
CAD of internal mammary bypass graft – 414.04
Aneurysm of the heart – 414.10
Cardiovascular Conditions
ICD-9-CM Procedure Codes
Coding for Cardiovascular Procedures
Remember that ICD-9-CM procedure codes are used for
hospital facility services.
Codes are found in Volume 3 of the ICD-9-CM.
Volume 3 has a separate Alphabetical and Tabular List
Codes are found by referring to the name of the Procedure
Bypass
Angioplasty
Repair
Insertion
Coding for Cardiovascular Procedures
Coronary Bypass Grafts
Main term(s): Bypass, coronary (aortocoronary)
Coded to Category 36.x
Code selection is based on the number of vessels involved in the
bypass.
If Mammary grafts are used to perform the bypass they are
coded separately.
Example:
CABG procedure using one saphenous vein to bypass the RCA
and one internal mammary graft – 36.11 and 36.15
CABG procedure involving two coronary vessels – 36.12
Coding for Cardiovascular Procedures
ICD9-CM Coding for Bypass Grafts – Questions to
Consider
What types of grafts were used?
(Saphenous vs. Internal Mammary)
Saphenous vein harvesting is included in the code for the
procedure.
Internal mammary artery is coded separately.
How many structures were bypassed?
Coronary Circulation
Left Main
Coronary
Artery (LCA)
Right Coronary
Artery (RCA)
Right marginal
Right posterior
Descending
Diagonal
Left anterior
descending
branch
Left Circumflex
(LC)
Septal
Obtuse
Marginal (OM)
Posterior
Descending
(PDA)
Posterolateral
Documentation Example
“…The acute marginal branch was grafted with
continuous 6-0 Prolene and the saphenous vein. The graft
was brought to the ascending aorta. The heart was turned
over; significant disease was seen in the proximal PDA.
A segment of saphenous vein was sewn in with 7-0
Prolene. The mid OM was opened; and anastomosis was
created. The graft was brought up to the aorta. Then the
diagonal branch of the artery was grafted side-to-side
with the left mammary. The distal LAD was opened and
grafted to the tip of the left mammary…”
Documentation Example (cont.)
marginal branch – Right marginal branch
proximal PDA – Posterior descending
mid OM – Obtuse Marginal
diagonal branch of the artery – Left diagonal
distal LAD – Left Anterior Descending branch
Five structures were bypassed
Two grafts were used - saphenous (included in code) and
Mammary (coded separately)
Code(s): 36.14 and 36.15
Coding for Cardiovascular Procedures
Cardiac Catheterizations
A diagnostic test used to identify, measure and verify
intracardiac conditions. Also used in conjunction with
more definitive procedures (i.e. angioplasties).
Coded to Category 37.2x
4th digits identify the area/side of the heart being studied.
Example:
37.21 – Right heart catheterization
37.22 – Left heart catheterization
37.23 – Combined right and left heart catheterization
Coding for Cardiovascular Procedures
Percutaneous Transluminal Coronary Angioplasty
PTCA
Used to relieve obstruction of coronary arteries.
When performed on non-coronary vessels it is referred to
as a PTA (Percutaneous Transluminal Angioplasty)
Needs several codes to fully report the procedure.
A code for the PTCA procedure
A code for the stent insertion (drug vs. non drug eluting)
A code for the number of stents inserted
A code for the number of vessels treated
Codes for any adjunct procedures
Coding for Cardiovascular Procedures
Example:
PTCA of left anterior descending artery and circumflex
vessels with insertion of three non-drug eluting stents
00.66, 36.07, 00.41, 00.47
Coding for Cardiovascular Procedures
Coding Practice:
1.
PTCA of left anterior descending artery with
insertion of single drug eluting stent.
2. CABG using double internal mammary coronary artery
grafts to bypass three coronary arteries
Coding for Cardiovascular Procedures
Coding Practice:
1.
00.66, 36.07, 00.40, 00.45
2. 36.13 and 36.16
Looking Ahead
Seminar
Topic:
Study Smart!