coding echos-rheumatic vs non-rheumatic

aparscal

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I just wanted to clarify when I am coding an echo (transthoracic echocardiogram) The providers are interpreting what they found in the valves. When a pt has both mitral valve and tricuspsid valve disorder (multiple valve diseases) we code a combo code I08.1-Rheumatic disorders of both mitral valve,and tricuspid valves. Per the guidance this automatically becomes rheumatic whether the provider documents this in the note or not.

My question is what if a pt pt only has tricupsid regurgitation?
the guidance (if I am following it right) guides me to non-rheumatic. I go to regurgation,valve,valvular-see endocarditis, tricupsid, non-rheumatic i36.8

I just want to make sure I am on the right track and following the ICD-10 guidance correctly. It seems when there is more than one valve disorder combination, the DX becomes rheumatic. and when they only have one its non-rheumatic. can someone shed some light on this for me?

thank you














 

thomas7331

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This is a confusing area for both coders and providers, and I think one of the things that throws many coders off is mistaking the code descriptors for the actual diagnosis. You have to keep in mind that the term 'rheumatic' in the descriptor does not mean that you are making the patient's diagnosis rheumatic or non-rheumatic, it's just that this is the code where you are reporting a particular diagnosis if is it not specified as one or the other in the documentation.

In this example, yo're following the right steps, but selecting the wrong entries in the alphabetic index, so you're arriving at the incorrect code here. Under 'regurgitation', you should select 'tricuspid', not 'valvular' because that is more specific, which would direct you to 'insufficiency, tricuspid' - I07.1. Also, if you did follow the entry to 'endocarditis', you cannot select the entry under endocarditis that states 'non-rheumatic' if that is not documented by the provider - you would have to choose just 'tricuspid', which directs you back to the I07 category again.

Don't let the code descriptors throw you off here. Although I07.1 has the descriptor 'Rheumatic', you'll notice under the entry for this in the tabular index that it states 'Tricuspid (valve) insufficiency (rheumatic)'. Per the ICD-10 guidelines, the parentheses indicate "supplementary words that may be present or absent in the statement of a disease or procedure without affecting the code number", so these do not have to appear in the documentation, whereas terms that are not in parentheses must be documented. So 'tricuspid insufficiency' is classified under this code.

With valve disease, there are cases where a diagnosis will end up taking you to a rheumatic or to a non-rheumatic code descriptor, and this is a case where you just have to pay careful attention to the index and use of the parentheses in order to arrive at the correct codes. Look at your includes and excludes not under each of the codes and this should help (for example, under I08, it states that 'multiple vale disease specified as rheumatic or unspecified' are included here, so this category of 'rheumatic' codes will include the unspecified disease.) I know this probably sounds confusing, but let me know if that helps some.
 

aparscal

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This is a confusing area for both coders and providers, and I think one of the things that throws many coders off is mistaking the code descriptors for the actual diagnosis. You have to keep in mind that the term 'rheumatic' in the descriptor does not mean that you are making the patient's diagnosis rheumatic or non-rheumatic, it's just that this is the code where you are reporting a particular diagnosis if is it not specified as one or the other in the documentation.

In this example, yo're following the right steps, but selecting the wrong entries in the alphabetic index, so you're arriving at the incorrect code here. Under 'regurgitation', you should select 'tricuspid', not 'valvular' because that is more specific, which would direct you to 'insufficiency, tricuspid' - I07.1. Also, if you did follow the entry to 'endocarditis', you cannot select the entry under endocarditis that states 'non-rheumatic' if that is not documented by the provider - you would have to choose just 'tricuspid', which directs you back to the I07 category again.

Don't let the code descriptors throw you off here. Although I07.1 has the descriptor 'Rheumatic', you'll notice under the entry for this in the tabular index that it states 'Tricuspid (valve) insufficiency (rheumatic)'. Per the ICD-10 guidelines, the parentheses indicate "supplementary words that may be present or absent in the statement of a disease or procedure without affecting the code number", so these do not have to appear in the documentation, whereas terms that are not in parentheses must be documented. So 'tricuspid insufficiency' is classified under this code.

With valve disease, there are cases where a diagnosis will end up taking you to a rheumatic or to a non-rheumatic code descriptor, and this is a case where you just have to pay careful attention to the index and use of the parentheses in order to arrive at the correct codes. Look at your includes and excludes not under each of the codes and this should help (for example, under I08, it states that 'multiple vale disease specified as rheumatic or unspecified' are included here, so this category of 'rheumatic' codes will include the unspecified disease.) I know this probably sounds confusing, but let me know if that helps some.
That is so extremely helpful. Thank you for explaining that so well. I did not realize Per the ICD-10 guidelines, the parentheses indicate "supplementary words that may be present or absent in the statement of a disease or procedure without affecting the code number", Now, I can code this with confidence!!
 

aparscal

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This is a confusing area for both coders and providers, and I think one of the things that throws many coders off is mistaking the code descriptors for the actual diagnosis. You have to keep in mind that the term 'rheumatic' in the descriptor does not mean that you are making the patient's diagnosis rheumatic or non-rheumatic, it's just that this is the code where you are reporting a particular diagnosis if is it not specified as one or the other in the documentation.

In this example, yo're following the right steps, but selecting the wrong entries in the alphabetic index, so you're arriving at the incorrect code here. Under 'regurgitation', you should select 'tricuspid', not 'valvular' because that is more specific, which would direct you to 'insufficiency, tricuspid' - I07.1. Also, if you did follow the entry to 'endocarditis', you cannot select the entry under endocarditis that states 'non-rheumatic' if that is not documented by the provider - you would have to choose just 'tricuspid', which directs you back to the I07 category again.

Don't let the code descriptors throw you off here. Although I07.1 has the descriptor 'Rheumatic', you'll notice under the entry for this in the tabular index that it states 'Tricuspid (valve) insufficiency (rheumatic)'. Per the ICD-10 guidelines, the parentheses indicate "supplementary words that may be present or absent in the statement of a disease or procedure without affecting the code number", so these do not have to appear in the documentation, whereas terms that are not in parentheses must be documented. So 'tricuspid insufficiency' is classified under this code.

With valve disease, there are cases where a diagnosis will end up taking you to a rheumatic or to a non-rheumatic code descriptor, and this is a case where you just have to pay careful attention to the index and use of the parentheses in order to arrive at the correct codes. Look at your includes and excludes not under each of the codes and this should help (for example, under I08, it states that 'multiple vale disease specified as rheumatic or unspecified' are included here, so this category of 'rheumatic' codes will include the unspecified disease.) I know this probably sounds confusing, but let me know if that helps some.

Let me ask you this, so I also came across another echo with aortic, mitral and pulmonic regurgitation. As I follow the guidance I get I08.0 for aortic and mitral valve regurgitation, and I37.1 for the pulmonic regurgitation. Do you agree with the codes?
 

thomas7331

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Let me ask you this, so I also came across another echo with aortic, mitral and pulmonic regurgitation. As I follow the guidance I get I08.0 for aortic and mitral valve regurgitation, and I37.1 for the pulmonic regurgitation. Do you agree with the codes?
This could be correct. However, there is an excludes1 note under the I08 category for codes in the I37 category. So, technically, in order to code I37.1 in addition to I08.0, you would need to meet the rule for the exception to the excludes1 note and confirm with the provider that the pulmonic regurgitation is unrelated to the other two.

If they are related, or if the provider cannot confirm one way or the other, then I would probably choose I08.8 to capture all three conditions due to the excludes1 note. But I think this would be one of those grey areas in ICD-10 where a coder may need to make a judgment call as the book does not take you definitively in one direction or the other here.
 
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aparscal

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This could be correct. However, there is an excludes1 note under the I08 category for codes in the I37 category. So, technically, in order to code I37.1 in addition to I08.0, you would need to meet the rule for the exception to the excludes1 note and confirm with the provider that the pulmonic regurgitation is unrelated to the other two.

If they are related, or if the provider cannot confirm one way or the other, then I would probably choose I08.8 to capture all three conditions due to the excludes1 note. But I think this would be one of those grey areas in ICD-10 where a coder may need to make a judgment call as the book does not take you definitively in one direction or the other here.
thank you for your help. I will re-read the excludes note and query the provider if necessary. thank you for all your help. this is extremely helpful.
 
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