Elevated Troponin or CK's

Icode4U

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QT syndrome & Troponin levels

Long QT Syndrome is referring to the rythum on the EKG.
The long QT syndrome (LQTS) is a disorder of myocardial repolarization characterized by a prolonged QT interval on the electrocardiogram (ECG) (show ECG 1) [1-3] . This syndrome is associated with an increased risk of a characteristic life-threatening cardiac arrhythmia, known as torsade de pointes (TdP) (show ECG 2A-2B) [4,5] . The primary symptoms in patients with LQTS include palpitations, syncope, seizures, and sudden cardiac death (SCD).

Troponin is a cardiac emzyme - measured in a serum laboratory test.
Clinical evidence of myocardial ischemia is necessary because serum troponin elevations are not necessarily due to an acute coronary syndrome (ACS). They can also be seen in a variety of other diseases, such as sepsis, hypovolemia, atrial fibrillation, heart failure, pulmonary embolism, myocarditis, myocardial contusion, and renal failure.
Criteria required to meet the definition include symptoms of ischemia, the use of laboratory tests (including cardiac biomarkers such as troponin, ECG, or specific imaging abnormalities), or pathologic findings. The criteria used to define myocardial infarction differ somewhat depending on the particular clinical circumstance of the patient: those suspected of acute MI based on their presentation; those undergoing either coronary artery bypass graft surgery or percutaneous intervention; or those who have sustained sudden unexpected, cardiac death (show table 1).
 

cld

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We use 790.6, other abnormal blood chemistry. I seems to work.
 

hyerden

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Elevated Troponin

Hi new to this, My concern is we are debating this right now. The diagnosis 790.6 Other abnormal blood chemistry does not seem specific. Diagnosis 790.5 is for abnormal serum enzyme levels which would fall under CPK ,Ck. But if we are looking for elevated troponin which is a protein 790.99 seems to fit better as this is an abnormal protein serum. My problem is one of the MD's thinks we should have something more specific. Any other help or advice would be appreciated.
 

Anna Weaver

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lab values

Unfortunately, there isn't really a definitive diagnosis for elevated troponins in and of itself. That's one of the reasons that we do not code from lab tests. It requires a physician to interpret those results and give us that diagnosis. If the patient has an elevated troponin, and the Dr doesn't give you anything else, that's all you can code. I use the 790.99 as there really isn't a diagnosis here, just abnormal findings.
This is also one of those that I think is coders discretion. There is sometimes such a number of choices, you have to pick what fits best and everyone will give you the answer they use and their reasoning as to why it's the right choice.
Good luck!
 
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elevated troponin level

Cardiac troponin is a preferred biomarker of acute myocardial infarction (MI). Unfortunately, elevation of troponin can be detected in a variety of conditions other than acute MI. This review focuses on the incidence and clinical significance of increased troponin in conditions commonly associated with troponin elevations, particularly in those that may resemble acute MI. So we can report for acute MI 410.90 for cases where patients are being reported with elevated cardiac troponin levels.

The other manifestations where we can see elevated cardiac troponin levels are as follows:
1. Acute Pericarditis
2. Acute Pulmonary Embolism
3. Acute or Severe Heart Failure
4. Myocarditis
5. Sepsis
6. Chronic Renal Failure

Cardiac troponin can be elevated in a variety of conditions other than acute MI. Therefore, an accurate diagnosis in a patient with elevated troponin relies heavily on the clinical information in that particular case.
 
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dclark7

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After much discussion with the doc's in my cardiology practice we have decided to use 790.5 for elevated troponins. Their reasoing is that this is a an enzyme, so 790.5 best describes the problem. According to them sometimes the troponins can be elevated beacuase of "demand ischemia", other factors occuring within the body that is causing increased demand on the heart. Of course if it is caused by an acute MI or any other of the many factors we code to the condition. We only use 790.5 if there is no clear cut dx.

Doreen, CPC
 

PURNIMA

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Hi,

Until now I was using the code 790.5 for both elevated CPKs and Troponin, but an article from WebMd made it clear on the ICD. The article says - "Cardiac enzyme studies measure the levels of the enzyme creatine phosphokinase (CPK, CK) and the protein troponin (TnI, TnT) in the blood. Low levels of these enzymes and proteins are normally found in your blood".

Meaning for elevated CPK and CK (cardiac enzyme), the ICD code is 790.5 and for Elevated Troponin (it is a protein, not enzyme), the ICD code is 790.99.

Hope this helps and thanks for this thread, it gives a clear picture.

Thank You,

Purnima S, CPC
 
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