Practice Management Alert

Question: My cardiologist performed a heart valve transplant on a patient who suffered from stenosis. The ICD-9 manual states that the heart valve replacement V code (V42.2) is now considered a secondary code, so I had planned on using stenosis as the primary diagnosis. My provider says that I shouldn't use that code because the patient no longer has stenosis. What's the right way to code this?

Iowa Subscriber

Answer: You are correct in your assessment that stenosis is involved in the primary diagnosis. You might gently remind your provider that coding is dependent on the reason for the surgery, not the outcome.

Your coding will involve one of the following ICD-9 codes: 394.x (Diseases of mitral valve), 395.x (Diseases of aortic valve), or 396.x (Diseases of mitral and aortic valves). After all, that was the primary reason the patient required the heart valve replacement (V42.2, Organ or tissue replaced by transplant; heart valve).

Because your question does not specify any other details about the procedure, you will likely use one of two other codes to describe the disease that prompted the replacement of the valve. For patients with rheumatic involvement that does not include the aortic valve, you should use 394.x. For patients without rheumatic involvement, use 424.0 (mitral valve disorders).