Cardiology Coding Alert

Beat These Cardiomyopathy Coding Challenges

Cardiomyopathy occurs when the heart muscle becomes enlarged or thickened, or doesn’t contract as it normally would, says Carol Hodge, CPC, CPMA, CDEO, CCC, CEMC, CPB, CFPC, COBGC, senior documentation specialist at St. Joseph’s/Candler Medical Group. This results in difficulty circulating blood throughout the body.

Cardiomyopathy can be acquired or hereditary, Hodge adds. Causes of acquired cardiomyopathy include viral diseases that affect the heart muscle or valves, underlying diseases that may cause cardiomyopathy, and side effects from chemotherapy. Cardiomyopathy may lead to heart failure, valve problems and arrhythmias. Cardiomyopathy patients usually have a reduced ejection fraction.

The biggest challenge for coding cardiomyopathy is specificity, says Rebecca Sanzone, CPC, CPMA, quality assurance specialist at St. Vincent Medical Group/Accension Health and coding consultant at the American College of Cardiology. You have to know what kind of cardiomyopathy the patient has in order to code correctly.

The main types of cardiomyopathy include dilated, hypertrophic, and restrictive, Sanzone explains.

“Without proper documentation, oftentimes an unspecified code is used,” she says. “On most [local coverage determinations] LCDs and [national coverage determinations] NCD from the Centers for Medicare & Medicaid Services (CMS), unspecified cardiomyopathy is not a covered indication. You must be specific on the type, which can be difficult to do without provider involvement.”

Ensuring the provider documents the type of cardiomyopathy is important in order for the coder to apply the correct ICD-10-CM code, Hodge reiterates. “For example, there is dilated cardiomyopathy, alcoholic cardiomyopathy, stress induced cardiomyopathy, also known as broken heart syndrome, among others.”

Reading the Code first guidelines and the Excludes notes is also important when selecting the diagnosis code, Hodge adds. For example, most of the cardiomyopathy codes fall under the I42- (Cardiomyopathy) section, but in the Excludes2 note, there is also ischemic cardiomyopathy, which is I25.5 (Ischemic cardiomyopathy).

Delve Into Hypertrophic Cardiomyopathy

One type of cardiomyopathy, hypertrophic cardiomyopathy, is usually caused by gene mutations. With hypertrophic cardiomyopathy, the heart muscle thickens and grows stiffer than usual. Because the heart muscle is thickened, it becomes more difficult for the heart to pump blood.

ICD-10-CM: If your cardiologist diagnoses a patient with hypertrophic cardiomyopathy, report either I42.1 (Obstructive hypertrophic cardiomyopathy) or I42.2 (Other hypertrophic cardiomyopathy).

Focus on 1 Code for Dilated Cardiomyopathy

Another type of cardiomyopathy, dilated cardiomyopathy (DCM), is the most common kind of cardiomyopathy.

DCM is when the heart chambers enlarge and lose their ability to contract, Sanzone says. It often starts in the left ventricle (bottom chamber). As the disease worsens, it may spread to the right ventricle and to the atria (top chambers).

The main causes of dilated cardiomyopathy include coronary heart disease; heart attack; high blood pressure; diabetes; thyroid disease; viral hepatitis and HIV; infections, especially viral infections that inflame the heart muscle; and alcohol, particularly for patients who also have a poor diet, per Sanzone:

ICD-10-CM: Report I42.0 (Dilated cardiomyopathy) for dilated cardiomyopathy. Code I42.0 also includes congestive cardiomyopathy.

Caution: Don’t mix up dilated cardiomyopathy and heart failure, Sanzone cautions.

“In congestive cardiomyopathy, also called dilated cardiomyopathy, the heart becomes stretched and weakened and is unable to pump effectively,” she says. “Heart failure occurs when the heart does not pump strongly enough to meet the needs of the body.”

See How to Report Restrictive Cardiomyopathy

With restrictive cardiomyopathy (RCM), the heart muscle scars, stiffens, or both, Sanzone says. RCM is a rare disease of the myocardium and is the least common of the three clinically recognized and described cardiomyopathies. It is characterized by diastolic dysfunction with restrictive ventricular physiology, whereas systolic function often remains normal.

ICD-10-CM: Report I42.5 (Other restrictive cardiomyopathy) for restrictive cardiomyopathy. This code also includes constrictive cardiomyopathy NOS.

Do This if Patient Has Alcoholic Cardiomyopathy

If a patient has alcoholic cardiomyopathy, you should report I42.6 (Alcoholic cardiomyopathy).

When you report I42.6, you should also code the presence of alcoholism from category F10- (Alcohol related disorders), per ICD-10-CM.

Example: The cardiologist documents that the patient has alcoholic cardiomyopathy and alcohol abuse with intoxication delirium. You should report codes I42.6 and F10.121 (Alcohol abuse with intoxication delirium) on your claim.

Handle Cardiomyopathy Due to Drugs With Ease

If your cardiologist documents cardiomyopathy due to drugs and an external agent, you should report code I42.7 (Cardiomyopathy due to drug and external agent).

Don’t miss: You should first report the poisoning due to drugs or toxin, if applicable, with codes T36- (Poisoning by, adverse effect of and underdosing of systemic antibiotics) through T65- (Toxic effect of other and unspecified substances), per ICD-10-CM. You should also report an additional code for adverse effect, if applicable, to identify the drug from categories T36- through T50- (Poisoning by, adverse effect of and underdosing of diuretics and other and unspecified drugs, medicaments and biological substances).