Cardiology Coding Alert

No documentation of rheumatic or nonrheumatic? Here’s what to do.

One of the most important parts of ICD-10 transition preparation is ensuring you’ve planned ahead to get the specific documentation you need to choose the most appropriate code. For heart valve disorders, that means making it simple for your physician to capture the nature of the disorder based on ICD-10 categories. Here are the areas to watch for nonrheumatic tricuspid valve disorders. 

ICD-9-CM Code

• 424.2, Tricuspid valve disorders, specified as nonrheumatic

ICD-10-CM Codes

• I36.0, Nonrheumatic tricuspid (valve) stenosis
  
• I36.1, Nonrheumatic tricuspid (valve) insufficiency
  
• I36.2, Nonrheumatic tricuspid (valve) stenosis with insufficiency
  
• I36.8, Other nonrheumatic tricuspid valve disorders
  
• I36.9, Nonrheumatic tricuspid valve disorder, unspecified
  

A disorder of the tricuspid valve refers to a problem with the valve between the heart’s right atrium and right ventricle.

ICD-9 coding rules: ICD-9 offers one code to cover tricuspid valve disorders specified as not rheumatic: 424.2. Among the notes with the code is an excludes note pointing you instead to 397.0 (Diseases of tricuspid valve) when documentation specifies “rheumatic” or doesn’t specify a cause.

ICD-10 changes: You’ll need to choose from multiple tricuspid valve disorder codes in the I36.- range under ICD-10. You’ll have separate codes for stenosis (I36.0), insufficiency (I36.1), stenosis with insufficiency (I36.2), other (I36.8), and unspecified (I36.9).

Remember to check the notes with the I36.- range (Nonrheumatic tricuspid valve disorders). For instance, as the first note below shows, if the documentation doesn’t specify cause, you will use a code from I07.- (Rheumatic tricuspid valve diseases).

Excludes1:

Tricuspid valve disorders of unspecified cause (I07.-)
Tricuspid valve disorders specified as congenital (Q22.4, Q22.8, Q22.9)
Tricuspid valve disorders specified as rheumatic (I07.-)
Tricuspid valve disorders with aortic and/or mitral valve involvement (I08.-).

Documentation: To support proper coding, the physician should document whether the tricuspid 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 tricuspid 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: When documentation shows both stenosis and insufficiency, you should choose single code I36.2 rather than reporting both I36.0 and I36.1. Also remember that physicians may document insufficiency using the terms 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.