Cardiology Coding Alert

Hint: Make sure you know which valve was involved.

During the session “Cardiovascular Pathophysiology Diagnostics and Therapeutic Procedures” at Regional HEALTHCON 2022, speaker Tyler Griffeth, CPC, CPRC, coding consultant at Intermountain Healthcare, discussed the different types of heart valve diseases/ disorders and valve repair options.

Take a look at all you need to know to keep your heart valve coding in tip-top shape.

Pinpoint Valve Disorder ICD-10-CM Codes

The different valves of the heart include pulmonary, aortic, tricuspid, and mitral, according to Griffeth. All of these valves are very important.

Rheumatic fever is a disease that can cause problems with the heart’s valves, per Griffeth. If strep throat or scarlet fever, which often affect children, go untreated, the patient may develop rheumatic fever.

Rheumatic fever is a disease that can cause problems with the heart’s valves, per Griffeth. If strep throat or scarlet fever goes untreated, and a lot of times this affects children, the patient may develop rheumatic fever.

“It is an autoimmune disease at that point because the body’s tissues become inflamed and the immune system is freaking out because the heart has this disease in it that it’s trying to fight, and it’s not winning,” Griffeth said. “The heart freaks out and starts attacking its own tissues. So, you’ve got degradation of the heart and joints with rheumatic fever.”

However, rheumatic fever used to be a bigger problem before antibiotics, according to Griffeth. Now, antibiotics will typically kill a streptococcus infection before it’s able to cause this issue.

Valve diseases can include both rheumatic and non-rheumatic disorders. Look to the following ICD-10-CM codes when reporting rheumatic valve disorders:

• I05.0 (Rheumatic mitral stenosis)-I05.9 (Rheumatic mitral valve disease, unspecified)
• I06.0 (Rheumatic aortic stenosis)-I06.9 (Rheumatic aortic valve disease, unspecified)
• I07.0 (Rheumatic tricuspid stenosis)-I07.9 (Rheumatic tricuspid valve disease, unspecified)
• I08.0 (Rheumatic disorders of both mitral and aortic valves)-I08.9 (Rheumatic multiple valve disease, unspecified)

On the other hand, non-rheumatic valve disorders include the following:

• I34.0 (Nonrheumatic mitral (valve) insufficiency)-I34.9 (Nonrheumatic mitral valve disorder, unspecified)
• I35.0 (Nonrheumatic aortic (valve) stenosis)-I35.9 (Nonrheumatic aortic valve disorder, unspecified)
• I36.0 (Nonrheumatic tricuspid (valve) stenosis)-I36.9 (Nonrheumatic tricuspid valve disorder, unspecified)
• I37.0 (Nonrheumatic pulmonary valve stenosis)-I37.9 (Nonrheumatic pulmonary valve disorder, unspecified)

Dive Into Valve Procedure Codes

Your CPT^® code choice depends on the how, what, and where for valve repair, per Griffeth. He discussed some of the options you have for the different types of valve procedures, including repair and replacement.

Mitral valve repair: Mitral valve repair codes include 33420 (Valvotomy, mitral valve; closed heart), 33422 (… open heart, with cardiopulmonary bypass), 33425 (Valvuloplasty, mitral valve, with cardiopulmonary bypass), 33426 (… with prosthetic ring), and 33427 (… radical reconstruction, with or without ring).

Example: One example of a mitral valve repair is when your cardiologist places an annuloplasty ring, according to Griffeth. They put the ring around the valve, and it helps tighten it without having to replace the valve.

Aortic valve replacement: Griffeth also identified the following code options for replacement of the aortic valve:

• 33405 (Replacement, aortic valve, open, with cardiopulmonary bypass; with prosthetic valve other than homograft or stentless valve) and 33406 (… with allograft valve (freehand))
• 33410 (… with stentless tissue valve)
• 33411 (Replacement, aortic valve; with aortic annulus enlargement, noncoronary sinus) through 33413 (… by translocation of autologous pulmonary valve with allograft replacement of pulmonary valve (Ross procedure))
• 33440 (Replacement, aortic valve; by translocation of autologous pulmonary valve and transventricular aortic annulus enlargement of the left ventricular outflow tract with valved conduit replacement of pulmonary valve (Ross-Konno procedure))

Mark Down TAVR, TAVI Procedures

Also, don’t forget your options when your cardiologist performs a transcatheter aortic valve replacement (TAVR) or transcatheter aortic valve implantation (TAVI), says Griffeth. These codes include 33361 (Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; percutaneous femoral artery approach) through +33369 (… cardiopulmonary bypass support with central arterial and venous cannulation (eg, aorta, right atrium, pulmonary artery) (List separately in addition to code for primary procedure)).

Usually with TAVR/TAVI procedures, two physicians perform the procedure: a cardiovascular intensivist and a cardiothoracic surgeon, Griffeth said. The cardiothoracic surgeon typically stands by because there could be a problem, and the physician might need to open the patient up immediately.

You also have some Category III choices for transcatheter mitral valve implementation/replacement (TMVI) including 0483T (Transcatheter mitral valve implantation/replacement (TMVI) with prosthetic valve; percutaneous approach, including transseptal puncture, when performed) and 0484T (… transthoracic exposure (eg, thoracotomy, transapical)).

Also, don’t forget your choices for transcatheter tricuspid valve repair. These include 0569T (Transcatheter tricuspid valve repair, percutaneous approach; initial prosthesis) and +0570T (… each additional prosthesis during same session (List separately in addition to code for primary procedure)), as well as 0646T (Transcatheter tricuspid valve implantation (TTVI)/ replacement with prosthetic valve, percutaneous approach, including right heart catheterization, temporary pacemaker insertion, and selective right ventricular or right atrial angiography, when performed).