Cardiology Coding Alert

Are you ready to code hypertensive crisis, stent stenosis, and congenital cases?

Your ICD-10 2017 prep should be underway by now, reviewing the codes you’re most likely to use and also checking out added and revised instructional notes that will affect the way you code when the new code set goes into effect on Oct. 1, 2016.

Reality: You need to allow time to adjust to updates because you’ve got to break old habits and create new ones, says Carol Pohlig, BSN, RN, CPC, ACS, senior coding and education specialist at the Hospital of the University of Pennsylvania.

Take a moment to assess your preparations by seeing if you know the answers to these three questions. If you don’t know the answer, you can check the “ICD-10-CM FY2017 Full PDF,” including the Tabular List, available at www.cdc.gov/nchs/icd/icd10cm.htm.

How Would You Answer These 3 Questions?

Question 1: New category I16.- (Hypertensive crisis) includes which of the following notes?

A. Code first any identified hypertensive disease (I10-I15)
B. Code also any identified hypertensive disease (I10-I15)
C. Excludes2 any identified hypertensive disease (I10-I15)

Question 2: True or False: New code T82.855 (Stenosis of coronary artery stent) requires a seventh character to identify initial, subsequent, or sequela.

Question 3: Which ICD-10 2017 code should you report for atresia of aortic arch?

A. Q25.21, Interruption of aortic arch
B. Q25.29, Other atresia of aorta
C. Neither of the above

Are You an ICD-10 Prep Champ?

Answer 1: B. When you report a code from new hypertensive crisis category I16.-, you also should code any identified hypertensive disease using a code from I10 to I15.-.

An explanation at the beginning of the ICD-10 Tabular states, “A code also note instructs that 2 codes may be required to fully describe a condition but the sequencing of the two codes is discretionary, depending on the severity of the conditions and the reason for the encounter.”

Hypertensive crisis involves a blood pressure increase so severe that it may result in a stroke, notes Kelly D. Dennis, ACS-AN, CANPC, CHCA, CPC, CPC-I, owner of Perfect Office Solutions in Leesburg, Fla. Citing information from the Mayo Clinic, Dennis explains that a patient experiencing urgent hypertensive crisis has extremely high blood pressure, but the patient’s condition doesn’t indicate organ damage. In contrast, emergency hypertensive crisis involves extremely high blood pressure that has resulted in internal organ damage that may lead to life-threatening complications.

Answer 2: True. New coronary stent stenosis addition T82.855- is incomplete until you add a seventh character:

A, Initial encounter
D, Subsequent encounter
S, Sequela.

If you look at T82.855 in the CDC’s PDF of the Tabular List, you may miss this seventh character requirement because the instruction is listed with T82.- (Complications of cardiac and vascular prosthetic devices, implants and grafts) as a requirement for all codes in T82.-.

Answer 3: A. A note with aortic arch interruption code Q25.21 lets you know it’s the correct choice for atresia of aortic arch. You will use “other” code Q25.29 for “atresia of aorta.” Atresia refers to when a patient is born with a typical body opening or tube structure absent or closed.