Cardiology Coding Alert

Watch for whether your I70.21- code needs to be paired with chronic total occlusion, too.

ICD-10’s notorious emphasis on laterality is evident in the codes for atherosclerosis. See which key words your provider needs to include for you to pinpoint the most accurate code.

ICD-9-CM Code

• 440.21, Atherosclerosis of native arteries of the extremities with intermittent claudication

ICD-10-CM Codes

• I70.211, Atherosclerosis of native arteries of extremities with intermittent claudication, right leg
• I70.212, Atherosclerosis of native arteries of extremities with intermittent claudication, left leg
• I70.213, Atherosclerosis of native arteries of extremities with intermittent claudication, bilateral legs
• I70.218, Atherosclerosis of native arteries of extremities with intermittent claudication, other extremity
• I70.219, Atherosclerosis of native arteries of extremities with intermittent claudication, unspecified extremity

Atherosclerosis refers to hardening and thickening of the arteries. Lack of blood to the muscles may cause claudication (pain or cramping). Intermittent indicates the pain comes and goes, typically resolving with rest. This code range applies to native arteries, meaning the patient’s arteries rather than a bypass graft that a physician surgically inserted.

ICD-9 coding rules: ICD-9 offers a single code for extremity atherosclerosis with intermittent claudication. For the 440.2x range, ICD-9 instructs you to use an additional code, if applicable, to identify chronic total occlusion of an extremity artery.

ICD-10 changes: ICD-10 expands your coding options by requiring you to use your code to indicate whether the patient’s condition is in the right leg, left leg, both legs, or another extremity. If the physician doesn’t specify which extremity is involved, you also have an “unspecified” code available. Like ICD-9, ICD-10 instructs you to use an additional code, if applicable, to identify chronic total occlusion of an extremity artery: I70.92 (Chronic total occlusion of artery of the extremities).

Documentation: For you to choose the most specific ICD-10 code, your provider will need to be specific about which extremity is involved, including which side of the body the extremity is on.

Coder Tips: Review the includes and excludes notes for the I70.- range and for the I70.2- range. You’ll learn that just as with ICD-9 coding, you should look elsewhere if you need to report atherosclerosis of a bypass graft (I70.30-I70.79). You’ll also learn that the I70.- range has a lengthy “use additional code to identify” list:

• Exposure to environmental tobacco smoke (Z77.22)
• History of tobacco use (Z87.891)
• Occupational exposure to environmental tobacco smoke (Z57.31)
• Tobacco dependence (F17.-)
• Tobacco use (Z72.0).

Remember: Congress delayed the ICD-10 compliance date of Oct. 1, 2014, until at least Oct. 1, 2015. CMS has proposed Oct. 1, 2015, as the new compliance date. 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.