Cardiology Coding Alert

Specific documentation of stenosis and insufficiency will simplify finding the proper code.

When you start using ICD-10 codes in place of ICD-9, your nonrheumatic pulmonary valve disorder code choices will multiply by five. But a little prep work will make choosing among the more specific codes easy to do.

ICD-9-CM Code

• 424.3, Pulmonary valve disorders

ICD-10-CM Code

• I37.0, Nonrheumatic pulmonary valve stenosis
• I37.1, Nonrheumatic pulmonary valve insufficiency
• I37.2, Nonrheumatic pulmonary valve stenosis with insufficiency
• I37.8, Other nonrheumatic pulmonary valve disorders
• I37.9, Nonrheumatic pulmonary valve disorder, unspecified

A disorder of the pulmonary valve refers to a problem with the valve between the right ventricle and the pulmonary artery.

ICD-9 coding rules: ICD-9 offers one code to cover pulmonary valve disorders not specified as rheumatic. Among the notes with the code is an excludes note pointing you instead to 397.1 (Rheumatic diseases of pulmonary valve) when documentation specifies “rheumatic.”

ICD-10 changes: You’ll need to choose from multiple pulmonary valve disorder codes in the I37.- range under ICD-10. You’ll have separate codes for stenosis (I37.0), insufficiency (I37.1), stenosis with insufficiency (I37.2), other (I37.8), and unspecified (I37.9).

Before you choose your code, remember to check the notes with the I37.- range, Nonrheumatic pulmonary valve disorders:

• Excludes1:

o Pulmonary valve disorder specified as congenital (Q22.1, Q22.2, Q22.3)
o Pulmonary valve disorder specified as rheumatic (I09.89).

Documentation: To support proper coding, the physician should take care to document whether the pulmonary valve disease is rheumatic or not rheumatic. Also alert physicians that you need to know whether the condition is congenital because it affects your code choice. Because you won’t have the one-code-fits-all option for pulmonary valve disorders under ICD-10, your physician’s documentation needs to specify the type of disorder for you to choose the most specific code.

Coder tips: Take note that when documentation shows both stenosis and insufficiency, you should choose single code I37.2 rather than reporting both I37.0 and I37.1. Also remember that insufficiency may be documented using incompetence or regurgitation.

Remember: CMS has announced Oct. 1, 2015, as the new compliance date for ICD-10. When ICD-10-CM goes into effect, 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.