Cardiology Coding Alert

Rely on category I12- for hypertensive CKD

Perusing the ICD-10 Official Guidelines for Coding and Reporting shows you that cardiology is one of the coding specialties with numerous specific rules to follow. If you’re not familiar with these rules, you could be putting your claims in serious jeopardy.

Answer the following questions to brush up on your ICD-10 knowledge.

Count On This Code For Type 2 MI

Question 1: What ICD-10 code should we report for myocardial infarction (MI) due to demand ischemia?

Answer 1: For MI due to demand ischemia, you should report I21.A1 (Myocardial infarction type 2). Code I21.A1 also covers myocardial infarction secondary to ischemic imbalance.

Don’t forget to submit a code for the underlying cause, such as D50.0 (Iron deficiency anemia secondary to blood loss (chronic))-D64.9 (Anemia, unspecified), if it’s known and applicable.

Caution: Do not report I24.8 (Other forms of acute ischemic heart disease) for the demand ischemia, according to the Guidelines. Sequencing of the type 2 MI or the underlying cause is dependent upon the circumstances of admission.

Look At Category I12- For Hypertensive CKD

Question 2: When should we code CKD as hypertensive?

Answer 2: “ICD-10-CM presumes a causal relationship between hypertension and heart involvement and between hypertension and kidney involvement as the two conditions are liked by the term ‘with’ in the alphabetic index,” according to the Guidelines. “These conditions should be coded as related even in the absence of provider documentation explicitly linking them, unless the documentation clearly states the conditions are unrelated and/or the provider has specifically documented a different cause for the kidney or heart disease.”

So, you should report a code from combination category I12- (Hypertensive chronic kidney disease) when both hypertension and a condition classifiable to category N18- (Chronic kidney disease (CKD)) are present, the Guidelines continue. You should report a code from combination category I13- (Hypertensive heart and chronic kidney disease) when there is hypertension with both heart and kidney involvement. The fourth or fifth character indicates the stage of CKD.

For example, the medical documentation indicates that the patient has hypertension and stage 5 CKD. The CKD is presumed a causal relationship with the hypertension.

You would report code I12.0 (Hypertensive chronic kidney disease with stage 5 chronic kidney disease or end stage renal disease), along with secondary code N18.5 (Chronic kidney disease, stage 5) to identify the stage of the CKD unless the documentation clearly states the conditions are unrelated and/or the provider has specifically documented a different cause for the kidney disease, says Christina Neighbors, MA, CPC, CCC, Coding Quality Auditor for Conifer Health Solutions, Coding Quality & Education Department, and member of AAPC’s Certified Cardiology Coder steering committee.

Not Sure Whether Dominant or Nondominant? Do This

Question 3: The patient has monoplegia of an upper limb following nontraumatic intracerebral hemorrhage affecting his right side. However, the physician did not indicate whether the patient’s dominant or nondominant side was affected. What should we do?

Answer 3: Codes from category I69- (Sequelae of cerebrovascular disease), [that specify hemiplegia, hemiparesis and monoplegia] identify whether the dominant or nondominant side is affected, according to the Guidelines. So, if the physician documents the affected side, but he does not specify whether it is dominant or nondominant, you should follow the following rules:

• Rule 1: For ambidextrous patients, the default should be dominant.
• Rule 2: If the left side is affected, the default is nondominant.
• Rule 3: If the right side is affected, the default is dominant.

Turn to Aftercare Code in This Case

Question 4: The patient suffered from a ST elevation (STEMI) MI involving the right coronary artery. Six weeks after his MI, he had to return to the cardiologist’s office to receive care related to his MI. What ICD-10 code should we report for this situation?

Answer 4: For encounters after the four-week time frame, if the patient is still receiving care related to his MI, you should report the appropriate aftercare code, rather than a code from category I21- (Acute myocardial infarction). You will need more details to choose the correct aftercare code, so query your provider.