Look Ahead at ICD-10-CM in 2018: Part 2

Look Ahead at ICD-10-CM in 2018: Part 2

Diagnosis coding for diseases of the circulatory system gets even more specific.

The ICD-10-CM Tabular List of Diseases and Injuries 2018 Addenda provides insight to future diagnosis coding. Let’s review what is new, deleted, and revised in chapter 9. Where appropriate for clarity, revised text is underlined.
Editor’s note: Last month we covered chapters 1-7 of the 2018 ICD-10-CM Addenda; chapter 8 has no changes; and next month we’ll provide a summary of chapters 10-21.

Chapter 9: Diseases of the Circulatory System (I00-I99)

Hypertensive Heart Disease
An Includes note in category I11 Hypertensive heart disease is revised to include I50.- Heart failure.
Acute Myocardial Infarction
The major change to category I21 Acute myocardial infarction is the addition of “type 1” to all types of ST-elevation myocardial infarction (STEMI) and Non-STEMI myocardial infarction (MI). An Excludes2 note in this subcategory, for example, is revised to “Subsequent type 1 myocardial infarction (I22.-).”
Subcategory I21.A Other type of myocardial infarction is added to differentiate types 2-5. As such, I21.A1 Myocardial infarction type 2 is added, with two applicable definitions:
Myocardial infarction due to demand ischemia
Myocardial infarction secondary to ischemic imbalance
I21.A1 specifies to, “Code also the underlying cause, if known and applicable, such as: anemia (D50.0-D649), chronic obstructive pulmonary disease (J44.-), heart failure (I50.-), paroxysmal tachycardia (I47.0-I47.9), renal failure (N17.0-N17.9) and shock (R57.0-R57.9).”
I21.A9 Other myocardial infarction type is subsequently added to include:
Myocardial infarction associated with revascularization procedure
Myocardial Infarction type 3
Myocardial Infarction type 4a
Myocardial Infarction type 4b
Myocardial Infarction, type 4c
Myocardial Infarction type 5
We are instructed to, “Code first, if applicable postprocedural myocardial infarction following cardiac surgery (I97.190) or postprocedural myocardial infarction during cardiac surgery (I97.790).”
We are also instructed to Code also complication, if known and applicable, such as:
(Acute) stent occlusion (T82.897-)
(Acute) stent stenosis (T82.857-)
(Acute) stent thrombosis (T82.867-)
Cardiac arrest due to underlying cardiac condition (I46.2)
Complication of percutaneous coronary intervention (PCI) (I97.89)
Occlusion of coronary artery bypass graft (T82.218-)
“Subsequent type 1 myocardial infarction” is added to category I22 Subsequent ST elevation (STEMI) and non-ST elevation (NSTEMI) myocardial infarction, as well. And an Excludes1 note is added for subsequent MI, types 2-5.
Under I24.8 Other forms of acute ischemic heart disease, an Excludes1 note is added for MI due to demand ischemia (I21.A1).
Under I25.7 Atherosclerosis of coronary artery bypass graft(s) and coronary artery of transplanted heart with angina pectoris, an Excludes1 note for T82.8- Other specified complications of cardiac and vascular prosthetic devices, implants and grafts is deleted, and under I25.710 an Excludes2 note for T82.8- is added.
Category I25.8 Other forms of chronic ischemic heart disease is revised to exclude (Excludes1) acute coronary occlusion with MI (I21.0-I21.9, I22.-) and acute coronary occlusion without MI (I24.0 Acute coronary thrombosis not resulting in myocardial infarction).
Pulmonary Heart Diseases
Category I27 Other pulmonary heart diseases adds four definitions:
Heritable pulmonary arterial hypertension
Idiopathic pulmonary arterial hypertension
Primary group 1 pulmonary hypertension
Primary pulmonary arterial hypertension
Pulmonary hypertension not otherwise specified (NOS) (I27.2) and secondary pulmonary hypertension (I27.2) are deleted from the Excludes1 note and replaced with P29.30 Persistent pulmonary hypertension of newborn; I27.20 Pulmonary hypertension, NOS; I27.21 Secondary pulmonary arterial hypertension; and I27.29 Secondary pulmonary hypertension.
“Pulmonary hypertension NOS” is deleted under subcategory I27.2 Other secondary pulmonary hypertension, and Excludes1 note I27.83 Eisenmenger’s syndrome is added.
Under added code I27.21 Secondary pulmonary arterial hypertension we are instructed to Code also associated conditions if applicable, or adverse effects of drugs or toxins, such as:
T50.5X5 Adverse effect of appetite depressants
Q20-Q28 Congenital heart disease
M33.2- Polymyositis
K76.6 Portal hypertension
M05.- Rheumatoid arthritis with rheumatoid factor
B65.- Schistosomiasis [bilharziasis]
M35.0- Sicca syndrome [Sjögren]
M34.- Systemic sclerosis
I27.22 Pulmonary hypertension due to left heart disease is also added and we are instructed to Code also associated left heart disease, if known, such as:
I08.- Multiple valve disease
I05.- Rheumatic mitral valve diseases
I06.- Rheumatic aortic valve diseases
I27.23 Pulmonary hypertension due to lung diseases and hypoxia is added, which includes Group 3 pulmonary hypertension. Code also associated lung disease, if known, such as:
J47.- Bronchiectasis
E84.0 Cystic fibrosis with pulmonary manifestations
J84.- Other interstitial lung disease
J90 Pleural effusion, not elsewhere classified
G47.3- Sleep apnea
Newly added I27.24 Chronic thromboembolic pulmonary hypertension includes Group 4 pulmonary hypertension. Code also associated pulmonary embolism, if applicable (I26.-, I27.82).
Newly added I27.29 Other secondary pulmonary hypertension includes:
Group 5 pulmonary hypertension
Pulmonary hypertension with unclear multifactorial mechanisms
Pulmonary hypertension due to hematologic disorders
Pulmonary hypertension due to metabolic disorders
Pulmonary hypertension due to other systemic disorders
Code also other known associated disorders, such as:
Chronic myeloid leukemia (C92.10-C92.22)
Essential thrombocythemia (D47.3)
Gaucher disease (E75.22)
Hypertensive chronic kidney disease with end stage renal disease (I12.0, I12.11, I13.2)
Hyperthyroidism (E05.-)
Hypothyroidism (E00-E03)
Polycythemia vera (D45)
Sarcoidosis (D86.-)
Newly added I27.83 Other specified pulmonary heart diseases includes three applicable definitions: Eisenmenger’s complex; (Irreversible) Eisenmenger’s disease; and Pulmonary hypertension with right shunt related to congenital heart disease. Code also known, underlying heart defect, such as:
Arterial septal defect Q21.1
Eisenmenger’s defect (Q21.8)
Patent ductus arteriosus (Q25.0)
Ventricular septal defect (Q21.0)
Lastly, in this category, under I27.89, Eisenmenger’s complex and syndrome are deleted as applicable definitions, as is the Excludes1 note for Eisenmenger’s defect (Q21.8).
Category I30 Acute pericarditis adds an Excludes1 note for viral pericarditis due to Coxsakie virus (B22.23) and under I34 Nonrheumatic mitral valve disorders an Excludes1 note removes Q23.3 and adds Q23.9.
In category I49 Other cardiac arrhythmias, an Excludes1 note is deleted, and a new Excludes2 note specifies Bradycardia NOS (R00.1 Bradycardia, unspecified).
Heart Failure
Category I50 Heart failure has two new definitions. Subcategories I50.2-I50.4 newly instruct us to “Code also end stage heart failure, if applicable (I50.84).”
I50.1 is revised, to “Left ventricular failure, unspecified.”
Category I50.2 Systolic (congestive) heart failure adds two definitions:
Heart failure with reduced ejection fraction [HFrEF]
Systolic left ventricular heart failure
Category I50.3 Diastolic (congestive) heart failure adds three definitions:
Diastolic left ventricular heart failure
Heart failure with normal ejection fraction
Heart failure with preserved ejection fraction [HFpEF]
Category I50.4 Combined systolic (congestive) and diastolic (congestive) heart failure adds two definitions:
Combined systolic and diastolic left ventricular heart failure
Heart failure with reduced ejection fraction and diastolic dysfunction
Subcategory I50.8 Other heart failure is added. Category I50.81 Right heart failure adds:
I50.810 Right heart failure, unspecified – with two definitions: “Right heart failure without mention of left heart failure” and “Right ventricular failure NOS”
I50.811 Acute right heart failure – with two definitions: “Acute isolated right heart failure” and “Acute (Isolated) right ventricular failure”
I50.812 Chronic right heart failure – with two definitions: “Chronic isolated right heart failure” and “Chronic (isolated) right ventricular failure”
I50.813 Acute on chronic right heart failure – with four definitions: “Acute on Chronic isolated right heart failure; Acute on chronic (isolated) right ventricular failure; Acute decompensation of chronic (isolated) right ventricular failure; and Acute exacerbation of chronic (isolated) right ventricular failure”
I50.814 Right heart failure due to left heart failure – with one definition: “Right ventricular failure secondary to left ventricular failure.” Code also the type of left ventricular failure, if known, (I50.2-I50.43). An Excludes1 is added, as well, for “Right heart failure with but not due to left heart failure (I50.82).”
I50.82 and I50.84 note to “Code also the type of left ventricular failure, such as systolic, diastolic, or combined, if known (I50.2-I50.43).” Also added are codes I50.83 High output heart failure and I50.89 Other heart failure.
Other Heart Disease
Numerous note deletions/additions, and just as many code description revisions, exist in categories I60-I69, I70-I79, I82, I96, and I97. There are too many to go into detail in one article, so be sure to review the Tabular Addenda for 2018 in its entirety.

Amy Pritchett
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Amy C. Pritchett, BSHA, CPC, CPMA, CPC-I, CANPC, CASCC, CEDC, CRC, CDEO, CCS, ICDCT-CM/PCS, C-AHI, has been a coder/auditor for over 20 years with her most recent position being held at Change Healthcare as a Manger of the Facility Coding Services Division. She has many years of experience in several different areas of coding and serves as an interim instructor in her hometown of Mobile, Ala. She shares her expertise in publications and as a lecturer at conferences such as Coding-Con for The Coding Institute. She has served as President and Vice President of the Mobile, Ala., local chapter and serves as Secretary for the 2017 year.

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