Cardiology Coding Alert

Never report injury codes from Chapter 19 for injuries that occur during a medical intervention.

In Cardiology Coding Alert Vol. 22, No. 8, you learned all about the ICD-10 2020 codes and what you should expect in your cardiology office. Recently, CMS released the latest ICD-10 Official Guidelines for Coding and Reporting. Whenever new ICD-10 guidelines are released, it is imperative that you carefully review them, says Arnold Beresh, DPM, CPC, CSFAC, in West Bloomfield, Michigan.

Although you won’t see a ton of cardiology-specific changes, there are general guideline changes you should be aware of to ensure clean claims in your practice. Read on to make sure your practice is prepared to take on the new ICD-10 2020 guidelines.

Don’t miss: Both the new codes and the guidelines will go into effect Oct. 1, 2019.

Notice Acute Myocardial Infarction Revisions

The ICD-10 guidelines devote an entire section to acute myocardial infarctions (AMIs). The 2020 guidelines did not add a new type this year. However, you will see a few new minor text revisions to Section 5, which is titled Other Types of Myocardial Infarction (MI).

Revisions: The new rules for Type 2 MIs now clarify that you should report I21.A1 (Myocardial infarction type 2) for Type 2 MI, which is an MI due to demand ischemia or secondary to ischemic imbalance. (Emphasis added). As you can see, in the old version of the guidelines, the text said balance and the 2020 guidelines added the imbalance.

If you look under the included diagnoses for I21.A1, you will notice that they include MIs due to demand ischemia and MIs secondary to ischemic imbalance. So, the new guidelines merely correct a typo so that the text in the guidelines matches the diagnoses for I21.A1.

Don’t miss: Also, the 2020 guidelines stipulate that you should report the underlying cause for the Type 2 MI first. This direction matches the code also note you will find under code I21.A1 in the ICD-10 tabular list.

This code also note directs you to code also the underlying cause of the Type 2 MI if known and applicable, such as anemia (D50.0-D64.9); chronic obstructive pulmonary disease (J44.-) heart failure (I50.-); paroxysmal tachycardia (I47.0-I47.9); renal failure (N17.0-N19); and shock (R57.0-R57.9).

Revisions: Another minor revision you will see is the addition of the word if in the Other Types of MI guidelines: If a type 2 AMI is described as NSTEMI or STEMI, only assign code I21.A1. (Emphasis added).

Look at this example from Christina Neighbors, MA, CPC, CCC, Coding Quality Auditor for Conifer Health Solutions, Coding Quality & Education Department, and member of AAPC’s Certified Cardiology Coder steering committee: A 56-year-old patient presents with atrial flutter. The EKG shows ischemic changes, and the troponins became elevated (NSTEMI). The physician’s diagnosis is atrial flutter and Type 2 MI due to demand ischemia.

You would report I48.92 (Unspecified atrial flutter) for the atrial flutter and I21.A1 for the Type 2 MI due to demand ischemia.

Reminder: Clinical evidence of overt ischemia versus no overt ischemia and the physician’s specific documentation (eg, Type 1 MI, Type 2 MI secondary to an underlying cause, or elevated troponins due to an underlying cause) is the determining factor, Neighbors explains.

Dial Into These Miscellaneous Guideline Additions

Don’t miss these miscellaneous ICD-10 guidelines additions you will want to make a note of when Oct. 1 rolls around.

Iatrogenic injuries: The ICD-10 2020 guidelines will add a paragraph concerning iatrogenic injuries. You should not report injury codes from Chapter 19 for injuries that occur during or as a result of a medical intervention, according to the guidelines. Instead, you should report the appropriate complication code.

T-codes: The new guidelines will offer you additional information on how to handle a case where the patient takes two or more drugs, medicinal, or biological substances.

If the patient takes two or more drugs, medicinal, or biological substances, then you should report each code individually, unless there is an appropriate combination code in the Table of Drugs and Chemicals, according to the guidelines.

Also, don’t miss this brand-new paragraph in the guidelines: If multiple unspecified drugs, medicinal or biological substances were taken, assign the appropriate code from subcategory T50.91 (Poisoning by, adverse effect of and underdosing of multiple unspecified drugs, medicaments and biological substances). This addition just gives you further instruction about how to report cases where the patient takes two or more drugs, medicinal, or biological substances.

Z-codes: The new guidelines will also offer further clarification for Z-codes. Under code Z71 (Persons encountering health services for other counseling and medical advice, not elsewhere classified), you will find specific direction to report Z71.84 (Encounter for health counseling related to travel) for health risk and safety counseling for future travel purposes.