Cardiology Coding Alert

Question:

Georgia Subscriber

Most likely, your manual uses the italics to catch your attention so you remember not to use 425.8 (Cardiomyopathy in other disease classified elsewhere) as a first-listed diagnosis. Instead, the italicized code represents a manifestation of another disease, which you should code first. A note under 425.8 instructs you to "code first underlying disease." Included in the list of underlying diseases is "sarcoidosis (135)." So on the claim, you should list 135 (Sarcoidosis) first and report 425.8 as a secondary code.

Note that 135 is one of the small number of valid three-digit ICD-9 codes. The code does not have any fourth or fifth digit options.

Helpful: You should find a guide to using your ICD-9 manual in the opening pages. For example, page xii of the AMA's 2010 professional edition (vol. 1 and 2) explains that the "code first" instruction indicates "an instructional note that directs the coder to sequence the underlying condition before the manifestation." In addition, the manual uses a blue dot to the left of 425.8, and the manual guide explains, "The blue dot before a code indicates that the code should not be reported as the first-listed (primary) diagnosis."

Diagnoses defined: Cardiomyopathy is a heart muscle disease that compromises the heart's ability to pump blood as it should, often resulting in congestive heart failure.

In patients with sarcoidosis, inflammation related to the immune response does not go away and small lumps of immune system cells form. These lumps (granulomas) can affect organ function.