Cardiology Coding Alert

Of the nine diagnostic codes most rejected by Medicare for lack of specificity, four of them are cardiac codes. So, to avoid claim rejections labeled as unprocessable, experts advise that you not truncate these codes:

401.x, essential hypertension

414.xx, other forms of chronic ischemic heart disease

440.2x, atherosclerosis of native arteries of extremities

786.5x, chest pains

Even though Medicare has been routinely rejecting claims with truncated diagnostic codes (including those for cardiology) since July 1996, some cardiology coders are still not coding to the highest level of specificity, explains Susan Garrison, CPC, CPC-H, MPC, CPAR, MCS, president of Hyatt, Imler, Ott and Blont, a coding and reimbursement firm in Atlanta.

Or, they may be assigning a fifth digit inaccurately, adds Sue Prophet, RRA, CCS, director of classification and coding for The Society for Clinical Coding in Chicago, citing the ICD-9 basic coding guidelines for outpatient and physician services that state one should code to the highest degree of certainty for each encounter.

Some coders mistakenly think this means that all diagnostic codes must have five digits, and thus they add a decimal and one or two zeros, she says.

Either way, Medicare and many other third-party payers consider such incomplete or inaccurate codes invalid, which result in additional denials, correspondence and delays, Garrison points out.

So here are eight tips to help you ensure you are optimally utilizing fifth digit diagnostic coding, which will enable your cardiology claims to be processed faster and cut the number of denials.

1. More digits; more detail. ICD-9-CM contains codes with either three, four, or five digits. Most three digit codes serve as headings for broad categories which need to be further divided. The fourth and fifth digits provide more detail about the nature of the disease or condition.

Categories are subdivided by adding a decimal point as well as a fourth and/or fifth digit. Codes with fourth digits are called subcategory codes; those with fifth digits are subclassifications.
For example,

401.x (essential hypertension) always requires a fourth digit to identify the type of hypertension.

414.xx (other forms of chronic ischemic heart disease) always requires a fifth digit to determine site of ischemia.

440.2x (atherosclerosis of native arteries of extremities) always requires a fifth digit to determine type of atherosclerosis.

786.5x (chest pain) always requires a fifth digit to identify site of pain.

Note: Although a cardiologist wouldnt list 250.0x (diabetes mellitus without mention of complication) as a primary diagnosis, he or she might use it as a secondary or tertiary diagnosis. If you do, remember it requires a fifth digit to identify the type of diabetes.

2. Use three-digit codes sparingly. Use a three digit diagnostic code only when no fourth or fifth digit is available. In [...]