Cardiology Coding Alert

Include these artery/extremity/issue bullets in your clinical documentation improvement training.

After all the waiting, worrying, and training, ICD-10 is here. That doesn’t mean the training has to end. You can use these tips on coding atherosclerosis with rest pain to help you bolster your skills as you adjust to using the new code set on a daily basis.

ICD-9-CM Code

• 440.22, Atherosclerosis of native arteries of the extremities with rest pain

ICD-10-CM Codes

• I70.221, Atherosclerosis of native arteries of extremities with rest pain, right leg
• I70.222, Atherosclerosis of native arteries of extremities with rest pain, left leg
• I70.223, Atherosclerosis of native arteries of extremities with rest pain, bilateral legs
• I70.228, Atherosclerosis of native arteries of extremities with rest pain, other extremity
• I70.229, Atherosclerosis of native arteries of extremities with rest pain, unspecified extremity

Atherosclerosis is a type of arteriosclerosis with buildup of plaque, or fatty deposits, on the walls of an artery; hardening and thickening of the artery walls can lead to coronary artery disease.

ICD-9 coding rules: The ICD-9 code for atherosclerosis with rest pain included any condition also classifiable to 440.21 (Atherosclerosis of native arteries of the extremities with intermittent claudication). You used 440.4 (Chronic total occlusion of artery of the extremities) as an additional code, if applicable.

A long Includes list with 440.22 let you know it was appropriate for documented terms such as arteriosclerosis, senile endarteritis, and vascular degeneration, among others.

What’s similar in ICD-10? Like the ICD-9 code, the ICD-10 codes include conditions classifiable to I70.21- (Atherosclerosis of native arteries of extremities with intermittent claudication).

Another similarity between the code sets relates to using an additional code for chronic total occlusion (CTO). A rule that applies to all of I70.2- (Atherosclerosis of native arteries of the extremities) tells you to use I70.92 (Chronic total occlusion of artery of the extremities) as an additional code when applicable.

You’ll also find an Includes list in ICD-10 that shares many of the conditions you saw in the ICD-9 list.

What’s different in ICD-10? The obvious difference between the ICD-9 and ICD-10 options for this diagnosis is that ICD-9 offers one code while ICD-10 offers five codes that differ based on the extremity involved: right, left, or bilateral legs; other extremity; or unspecified extremity.

Documentation: Providers should already be documenting the site, but they can be sure documentation matches the additional expanded options for extremity atherosclerosis subcategory I70.2- by reviewing the “Coder tips” below.

Coder tips: To choose among the impressive increase in atherosclerosis codes in ICD-10, clinical documentation improvement should focus on these elements.

Artery/Graft

• Aorta
• Renal artery
• Native arteries
• Bypass graft

Autologous vein
Nonautologous biological
Nonbiological
Other

• Generalized
• Other

Extremity

• Right leg
• Left leg
• Bilateral legs
• Other extremity

Related Issues

• Intermittent claudication
• Rest pain
• Gangrene
• Ulceration

Thigh
Calf
Ankle
Heel and midfoot
Other part of foot
Other part of leg

Remember: Oct. 1, 2015, was the implementation date for ICD-10. You should apply the code set and official guidelines in effect for the date of service reported. Learn more at www.cms.gov/ICD10/ and www.cdc.gov/nchs/icd/icd10cm.htm#10update .