Cardiology Coding Alert

Report I30.1 for infective pericarditis.

When your cardiologist treats heart inflammation, such as pericarditis, you must pay close attention to details in the documentation to report the appropriate ICD-10-CM code. For example, you should know if the pericarditis is acute or chronic.

Answer the following questions to keep your claims in tip-top shape.

Define Pericarditis

Question 1: What is pericarditis?

Answer: Pericarditis is the inflammation of the pericardium, otherwise referred to as the pericardial sac, says Rebecca Sanzone, CPC, CPMA, quality assurance specialist at St. Vincent Medical Group/Accension Health and coding consultant at the American College of Cardiology. Inflammation of the pericardium may also be associated with certain complications such as pericardial effusion, cardiac tamponade, constrictive pericarditis, and effusive constrictive pericarditis.

Pericarditis can be acute onset, incessant, chronic, or recurrent, explains Catherine Brink, BS, CPC, CMM, president of Healthcare Resource Management in Spring Lake, New Jersey

Symptoms of pericarditis include sudden onset of severe chest pain, which is usually less severe sitting than lying down, Brink says. Other symptoms can include fever, shortness of breath, and palpitations.

Uncover Numerous Causes

Question 2: What causes pericarditis?

Answer: There are multiple causes of pericarditis, such as infection, autoimmune disorders, chest injury, cardiac surgery, etc., says Carol Hodge, CPC, CPMA, CDEO, CCC, CEMC, CPB, CFPC, COBGC, senior documentation specialist at St. Joseph’s/Candler Medical Group. Determining what type of pericarditis the patient has can be a challenge to the coder.

Report These ICD-10-CM Codes for Pericarditis

Question 3: What ICD-10-CM codes should you report for pericarditis?

Answer: You should look to the following ICD-10-CM codes when reporting pericarditis:

• I30.0 (Acute nonspecific idiopathic pericarditis)
• I30.1 (Infective pericarditis)
• I30.8 (Other forms of acute pericarditis)
• I30.9 (Acute pericarditis, unspecified)
• I31.0 (Chronic adhesive pericarditis)
• 131.1 (Chronic constrictive pericarditis)
• I31.2 (Hemopericardium, not elsewhere classified)
• I31.3 (Pericardial effusion (noninflammatory)
• I31.4 (Cardiac tamponade) Note: ICD-10-CM advises you to code first the underlying cause.
• I31.8 (Other specified diseases of pericardium)
• I31.9 (Disease of pericardium, unspecified)
• I32 (Pericarditis in diseases classified elsewhere)

Observe Diagnosis Tools

Question 4: How is pericarditis diagnosed?

Answer: Diagnosis is based on chest pain, pericardial rub, electrocardiogram (EKG), fluid around the heart, chest X-ray, and echocardiogram, Brink says.

Follow Expert Documentation Tips

Question 5: What are some documentation tips for pericarditis?

Answer: “It is important that providers document the type of pericarditis the patient has based on history, exam, test results, etc.,” Hodge says. “Acute pericarditis falls under the I30- codes, and the chronic types of pericarditis fall under the I31- codes. Code I32 is for pericarditis in diseases classified elsewhere.”

For example, patients with systemic lupus erythematosus may be more prone to develop pericarditis, Hodge adds. In these patients the codes on your claim would be M32.12 (Pericarditis in systemic lupus erythematosus) for the lupus followed by I32 because there is a Code first note under I32.

“Educate your providers on the different types of ICD-10-CM codes for pericarditis so they will be able to give the most specific diagnosis possible based on their exam, echocardiogram results, labs, etc.,” Hodge says. “If there is no known cause of the pericarditis, the correct code would be I30.0.”

Knowing any underlying causes, etiology of pericarditis, and to use the appropriate ICD-10-CM code to report it correctly is important for accurate reimbursement, Brink adds.