Cardiology Coding Alert

Hint: You will gain new code P09.5.

The Centers for Medicare & Medicaid Services (CMS) recently released the new ICD-10-CM 2022 codes. However, you will only see a few new cardiology-specific codes this year. Most of the changes involve new, revised, and deleted coding notes.

Read on to prep your cardiology practice for these new codes.

Editor’s note: These codes will go into effect Oct. 1, 2021.

Explore New "Non-Ischemic" Code I5A

You will gain new code I5A (Non-ischemic myocardial injury (non-traumatic)) in 2022. This code will also include acute (non-ischemic) myocardial injury, chronic (non-ischemic) myocardial injury, and unspecified (non-ischemic) myocardial injury.

With code I5A, you will also get an important code first note. You should first code the underlying cause if known and applicable. Causes can include the following:

• Acute kidney failure (N17.-)
• Acute myocarditis (I40.-)
• Cardiomyopathy (I42.-)
• Chronic kidney disease (CKD) (N18.-)
• Heart failure (I50.-)
• Hypertensive urgency (I16.0)
• Nonrheumatic aortic valve disorders (I35.-)
• Paroxysmal tachycardia (I47.-)
• Pulmonary embolism (I26.-)
• Pulmonary hypertension (I27.0, I27.2-)
• Sepsis (A41.-)
• Takotsubo syndrome (I51.81)

You will also gain a couple of new Excludes notes with code I5A. For example, an Excludes1 note includes acute myocardial infarction (121.-), as well as injury of the heart (S26.-). In addition, an Excludes2 note includes other acute ischemic heart diseases (I24.-).

Observe These I5A Coding Notes

You will also see several more coding notes that have been revised to include brand-new code I5A.

In Chapter 9 of ICD-10-CM, which encompasses diseases of the circulatory system, you will see a revision right at the beginning. For example, the text reads, “This chapter contains the following blocks: I30-I52 I5A (Other forms of heart disease).” (Emphasis added).

Ischemic heart diseases: For ischemic heart diseases (categories I20-I25), a use additional code note was deleted. You will get a new note that instructs you to code also the presence of hypertension (I10-I16).

Other acute ischemic heart diseases: For category I24 (Other acute ischemic heart diseases), you will gain a new Excludes2 note that encompasses non-ischemic myocardial injury (I5A).

Chronic ischemic heart diseases: For category I25 (Chronic ischemic heart disease), you will get a new Excludes2 note that encompasses non-ischemic myocardial injury (I5A).

“Patients with aggressively rising and/or falling cardiac troponins (cTn) without evidence of myocardial ischemia will be coded with I5A on October 1, 2021,” says Robin Peterson, CPC, CPMA, Manager of Professional Coding, Pinnacle Integrated Coding Solutions, LLC. “Myocardial injury is categorized as either ischemic or non-ischemic. As the code defines, I5A covers acute, non-acute, or unspecified myocardial injury.

Non-ischemic myocardial injury is caused by several conditions and has been seen increasingly in patients with COVID-19, Peterson adds. It’s important to talk with your providers and ask them to document whether the patient has ischemia or another underlying condition to appropriately code myocardial injury this fall.

See New Neonatal Screening Code P09.5

The second new cardiology-specific code you will gain in 2022 is P09.5 (Abnormal findings on neonatal screening for critical congenital heart disease). This code also includes neonatal congenital heart disease screening failure.

Don’t miss: Code P09.5 is only one of a slew of new neonatal screening codes you will see in 2022. You will also gain the following:

• P09.1 (Abnormal findings on neonatal screening for inborn errors of metabolism)
• P09.2 (Abnormal findings on neonatal screening for congenital endocrine disease)
• P09.3 (Abnormal findings on neonatal screening for congenital hematologic disorders)
• P09.4 (Abnormal findings on neonatal screening for cystic fibrosis)
• P09.6 (Abnormal findings on neonatal screening for neonatal hearing loss)
• P09.8 (Other abnormal findings on neonatal screening)
• P09.9 (Abnormal findings on neonatal screening, unspecified)

Don’t Miss These Miscellaneous Code Note Deletions and Revisions

Category I83 (Varicose veins of lower extremities) will get a new Excludes2 note — varicose veins complicating pregnancy (O22.0-). This note includes varicose veins complicating the puerperium (O87.4).

Additionally, category I50 (Heart failure) will lose Excludes1 note: neonatal cardiac failure (P29.0). However, a new Excludes2 note: neonatal cardiac failure (P20.0) will be added.

Finally, you will see a revision to code Z82.4 (Family history of ischemic heart disease and other diseases of the circulatory system). The new coding note will read as follows: Conditions classifiable to I00-I52 I5A, I65-I99. (Emphasis added). As you can see, this revision now includes new code I5A.