Cardiology Coding Alert

Pulmonary hypertension and the index could see changes, too.

Heart failure coding could be set for a pretty big overhaul as part of the Oct. 1, 2016, ICD-10 update, as you saw in “New Proposed Codes Could Change Your Heart Failure Coding in October.” But there are plenty of other possible changes for the ICD-10 2017 code set, too. Here’s what could be in store for atrial fibrillation, pulmonary hypertension, and other diagnoses you may see in your cardiology practice.

Watch for Potential A-Fib Additions

David Berglund, MD, presented on proposed changes to coding atrial fibrillation. The proposed changes include adding these new codes:

• I48.20, Chronic atrial fibrillation, unspecified
• I48.21, Longstanding persistent atrial fibrillation
• I48.22, Permanent atrial fibrillation
• I48.81, First detected atrial fibrillation
• I48.89, Other atrial fibrillation and flutter.

I48.2-: Currently, I48.2 (Chronic atrial fibrillation) is a complete code that is also appropriate for permanent atrial fibrillation. The proposed changes would turn I48.2 into an incomplete code requiring a fifth character to identify the diagnosis as chronic unspecified, longstanding persistent, or permanent.

The agenda provided these definitions:

• Persistent atrial fibrillation: “Cases that do not terminate within seven days, or that require repeat pharmacological or electrical cardioversion”
• Longstanding persistent atrial fibrillation: “Persistent and continuous atrial fibrillation lasting longer than one year”
• Permanent atrial fibrillation: “Persistent or longstanding persistent atrial fibrillation where cardioversion is not indicated, or cannot or will not be performed.”

I48.8-: American Hospital Association representative Nelly Leon-Chisen wanted to dive deeper into proposed “first detected” code I48.81. She suggested not adopting a “first detected” code unless there was a clinical reason to add such language and a clear approach.

It’s worth noting that the proposed “first detected” code would be a secondary code to another A-Fib code. The proposal includes this instruction with I48.81:

1. Code first the type of atrial fibrillation, such as:

• Paroxysmal atrial fibrillation (I48.0)
• Persistent atrial fibrillation (I48.1).

The agenda provided these guidelines for understanding first detected A-Fib:

• “First-detected atrial fibrillation is a case of atrial fibril­lation with no available prior history of atrial fibrillation. There is no certainty about the presence or absence of prior episodes or about the duration of the episode.”
• “First detected episodes of atrial fibrillation are classified as paroxysmal when they terminate, or persistent when they last for more than seven days.”

A note on notes: Other proposed A-Fib changes include adding notes to various codes to “code also” other arrhythmias and mitral valve insufficiency diagnoses commonly found with A-Fib.

Outlook: Sue Bowman of AHIMA asked whether the level of detail was truly necessary. According to the summary of the meeting, the ACC has seen the proposed changes but has not yet provided a definite response on support.

Pick Up on Pulmonary Hypertension Possibilities

Clinicians classify pulmonary hypertension (PH) into five groups based on cause. Bayer HealthCare Pharmaceuticals requested new codes in line with this classification.

For example, Group 2 is pulmonary hypertension due to left heart disease. The proposed new code for Group 2 is:

I27.21, Pulmonary hypertension due to left heart disease

Group 2 pulmonary hypertension

• Pulmonary hypertension due to left heart diastolic dysfunction
• Pulmonary hypertension due to left heart systolic dysfunction
• Pulmonary hypertension due to left heart valvular disease

Code also associated left heart disease, if known, such as:

• Diastolic heart failure (I50.3-)
• Nonrheumatic aortic valve disorders (I35.-)
• Nonrheumatic mitral valve disorders (I34.-)
• Rheumatic mitral valve diseases (I05.-)
• Rheumatic aortic valve diseases (I06.-)
• Systolic heart failure (I50.2-).

Outlook: Bowman and Leon-Chisen both wanted input from specialty societies on clinical necessity before considering adding such a large number of codes and notes.

But rather than being burdensome, the proposed changes would be intuitive to experts in the field, according to David Platt, MD, of Bayer, who provided the clinical presentation.

Take a Quick Look at Angina, Heart Beat, and CABG Complication

The proposals also include some smaller scale changes to the Tabular and Index that affect cardiology coding.

Angina: One proposed change would shift your coding for stable angina from I20.9 (Angina pectoris, unspecified) to I20.8 (Other forms of angina pectoris).

Heart beat: Another proposed change would affect R00 (Abnormalities of heart beat). Currently, this code has an Excludes1 note for specified arrhythmias (I47-I49). The proposed change switches the note to Excludes2.

You also may see R01.1 (Cardiac murmur, unspecified) gain the synonym “Systolic murmur NOS.” In contrast, the ICD-10 2016 Index entry for “Murmur, systolic (valvular)” says to “see Endocarditis.”

CABG complication: A proposed Index change for “Complication(s) (from) (of); coronary artery (bypass) graft; specified type NEC” changes the coding from T82.897- (Other specified complication of cardiac prosthetic devices, implants and grafts) to T82.898- (Other specified complication of vascular prosthetic devices, implants and grafts).

Resources: These proposals were discussed at the ICD-10 Coordination and Maintenance Committee Meeting Sept. 22-23, 2015. You can review the Diagnosis Agenda at www.cdc.gov/nchs/data/icd/Topic_Packet_09_22_23_15.pdf. The meeting summary is posted at www.cdc.gov/nchs/data/icd/2015_09_23_2015_Summary_Final.pdf.