Have a Heart – Cardiac Overview
This month’s A&P spotlight is on the heart. With each heartbeat, blood is sent throughout our bodies, carrying oxygen and nutrients to all of our cells. We are going to take a look at this amazing muscle along with some common conditions and how they will look in ICD-10-CM. Without a strong understanding of the anatomy of the heart, coders will struggle to assign the correct codes in ICD-10-CM.
The heart is the pumping station of the cardiovascular system. It is often referred to as the hardest working muscle in the human body. It sits between the lungs and behind the sternum. It is a fist-sized, cone-shaped muscle that beats nearly 115,000 times per day at an average rate of 80 times a minute. The heart has four chambers: the atria (two upper chambers) and the ventricles (two lower chambers). Left ventricular hypertrophy (LVH) is an enlargement of the left ventricle and may be due to several different things. The most common cause is high blood pressure. LVH increases the risk of myocardial infarction, stroke, and death. In ICD-10-CM, the code for left ventricular hypertrophy is I51.7 Cardiomegaly.
The heart is divided into right and left sides by a septum (a muscular wall). While in utero, there is normally an opening between the atria to allow blood to flow around the lungs. The right and left ventricles are also not separated. If the walls don’t completely form by birth, the holes are considered septal defects. Ventricular septal defect is one of the most common congenital heart defects. These are congenital conditions; therefore, they are located in Chapter 17 of ICD-10-CM. Code Q21.0 denotes a ventricular septal defect and Q21.1 denotes an atrial septal defect.
The heart also has four valves: tricuspid, mitral, pulmonary, and aortic. These valves are fibrous cusps that help the flow of blood throughout the heart by opening to permit blood flow and closing to prevent backflow of blood. The chordae tendineae are tendons made up mostly of collagen that link the papillary muscles to the tricuspid valve in the right ventricle and the mitral valve in the left ventricle. As the papillary muscles contract and relax, the chordae tendineae (sometimes called the heart strings) transmit the resulting increase and decrease in tension to the respective valves, causing them to open and close. Examples of ICD-10-CM codes for these conditions include: I34.2 Nonrheumatic mitral (valve) stenosis, I35.2 Nonrheumatic aortic (valve) stenosis and insufficiency, and I07.1 Rheumatic tricuspid insufficiency. There are also combination codes if multiple valves are diseased. For example, I08.2 Rheumatic disorders of both aortic and tricuspid valves.
This is just the “tip of the iceberg” for the cardiovascular system. In coming newsletters, we will revisit this system and delve deeper. The more you understand the structure and function of the organ systems, the more efficient and secure you will be in your coding in ICD-10-CM.