Cardiology Coding Alert

Do you know what 'omit code' means for benign murmurs?

When details are lacking for a patient's heart murmur, ICD-9 offers you a single code. But ICD-10 will add one more option for you to consider.

• 785.2, Undiagnosed cardiac murmurs

• R01.0, Benign and innocent cardiac murmurs
• R01.1, Cardiac murmur, unspecified

A cardiac murmur refers to abnormal heart sounds caused by turbulent blood. The murmur itself is not a disease, but it may indicate an underlying problem.

ICD-9 coding rules: An inclusion note with 785.2 instructs that the code is appropriate for "Heart murmur NOS" (not otherwise specified). Interestingly, if you search the ICD-9 index, under the "Murmur" entry, you'll discover the note "omit code" for benign, functional, innocent, insignificant, Still's, or vibratory murmurs. This language was added to make it clear that you shouldn't report an ICD-9 code for benign murmurs on your claim.

ICD-10 changes: ICD-10 includes a code specific to benign and innocent murmurs at R01.0. Functional, innocent, and nonorganic murmurs also fall under that code. When ICD-10 goes into effect, keep an eye out for guidelines on whether you should report a code for those benign murmurs. Unspecified code R01.1 includes heart murmur NOS or cardiac bruit NOS.

Documentation: Code R01.1 is an "unspecified" code, meaning the documentation doesn't specify the precise kind of murmur the patient has. In some cases, R01.1 may be your only option, but if the clinician specifies the murmur type, you should look for a more appropriate code. For example, ICD-10 indexes pulmonic valve murmur to I37.8 (Other nonrheumatic pulmonary valve disorders).

Coder tips: If the cardiac murmur originated during the perinatal period, you should code it to P29.8- (Other cardiovascular disorders originating in the perinatal period) rather than using R01.-, ICD-10 instructs.

Remember: When ICD-10-CM goes into effect on Oct. 1, 2013, 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.