Cardiology Coding Alert

Hint: Always read code first notes.

When you report septic embolisms, you must look for important details in the medical record such as the embolus’ origin and the final location. This will help you know whether the embolism is arterial or pulmonary.

Follow this helpful advice and never miss a beat when it comes to septic embolisms.

Report I76 for Septic Arterial Embolisms

An arterial septic embolism is a type of blood clot that contains bacteria, says Carol Hodge, CPC, CPMA, CDEO, CCC, CEMC, CPB, CFPC, COBGC, senior documentation specialist at St. Joseph’s/Candler Medical Group. It occurs when an infection starts in another part of the body and a clot containing bacteria breaks from the area of infection and travels through the arterial system until it blocks a blood vessel in a part of the body away from the infection.

The code for an arterial septic embolism is I76 (Septic arterial embolism), per Hodge.

Identify Presence of Acute Cor Pulmonale for Pulmonary Embolisms

A septic pulmonary embolus originates from a localized infection such as a localized cellulitis or a central venous catheter infection. The embolic material travels through the venous system to the right side of the heart and moves into the pulmonary arterial system where it lodges in small vessels.

For septic pulmonary embolisms, you should report either I26.01 (Septic pulmonary embolism with acute cor pulmonale) or I26.90 (Septic pulmonary embolism without acute cor pulmonale).

Don’t miss: As you can see, the code descriptor for I26.01 specifies a septic pulmonary embolism “with acute cor pulmonale.” On the other hand, the descriptor for I26.90 is for a septic pulmonary embolism “without acute cor pulmonale.” However, if your cardiologist doesn’t identify the specific type of pulmonary embolism, report I26.99 (Other pulmonary embolism without acute cor pulmonale). Code I26.99 also includes the conditions “acute pulmonary embolism NOS” and “pulmonary embolism NOS.”

Mind Sequencing Rules for Septic Embolisms

Whether reporting septic arterial or pulmonary embolisms, never report these codes as the primary diagnosis on your claim. Instead, in the ICD-10-CM code book, septic embolism codes come with the instructions to “code first the underlying infection.”

Certain medical conditions have both underlying etiology and manifestations, explains Catherine Brink, BS, CPC, CMM, president of Healthcare Resource Management in Spring Lake, New Jersey.

Diagnosis code sequencing is the medical condition, etiology, first, followed by the manifestation, according to Brink. Whenever such combination exists in the ICD-10-CM code book, there is a note to “code first” with the manifestation code and a “use additional code” note with the etiology code.

Example: Before coding I76, code first the underlying infection, for example infective endocarditis (I33.0), Hodge says. After I76, report an additional code to identify the site of the embolism, for example, I74.2 (Embolism and thrombosis of arteries of the upper extremities). So, if a patient with infective endocarditis developed a septic embolism in the left upper extremity, report:

• I33.0 (Acute and subacute infective endocarditis)
• I76
• I74.2

Conquer Septic Embolism Coding Challenges

Coding septic arterial and/or pulmonary embolisms is challenging because of the amount of detail that is required to be documented by the provider in order to code the septic embolism correctly, according to Hodge. Documentation must include the type of underlying infection, the diagnosis of the septic embolism itself, and where the embolism is located. If this information is not documented, query your provider for clarification.

Coders face four challenges when assigning ICD-10-CM codes for septic embolisms: what type is it, what’s the underlying infection, where’s the site, and then following the Excludes 2 notes for each diagnosis and for the block of diagnosis codes I00-I99, says Robin Peterson, CPC, CPMA, manager of professional coding services, Pinnacle Integrated Coding Solutions, LLC in Centennial, Colorado.

An Excludes 2 note indicates that the condition excluded is not part of the condition represented by the code, but a patient may have both conditions at the same time, Peterson adds. When an Excludes 2 note appears under a code, it is acceptable to use both the code and the excluded code together, when appropriate.

“It is important to always read and follow the instructional notes associated with each diagnosis code when coding septic embolisms,” according to Peterson. “And if necessary, submit a query to the provider for additional information and clarification.”