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Have a Heart – Cardiac Overview
This month's A&P spotlight is on the heart. With each heartbeat, blood is sent throughout our bodies, carrying oxygen and nutrients to all of our cells. We are going to take a look at this amazing muscle along with some common conditions and how they will look in ICD-10-CM. Without a strong understanding of the anatomy of the heart, coders will struggle to assign the correct codes in ICD-10-CM.
The heart is the pumping station of the cardiovascular system. It is often referred to as the hardest working muscle in the human body. It sits between the lungs and behind the sternum. It is a fist-sized, cone-shaped muscle that beats nearly 115,000 times per day at an average rate of 80 times a minute. The heart has four chambers: the atria (two upper chambers) and the ventricles (two lower chambers). Left ventricular hypertrophy (LVH) is an enlargement of the left ventricle and may be due to several different things. The most common cause is high blood pressure. LVH increases the risk of myocardial infarction, stroke, and death. In ICD-10-CM, the code for left ventricular hypertrophy is I51.7 Cardiomegaly.
The heart is divided into right and left sides by a septum (a muscular wall). While in utero, there is normally an opening between the atria to allow blood to flow around the lungs. The right and left ventricles are also not separated. If the walls don't completely form by birth, the holes are considered septal defects. Ventricular septal defect is one of the most common congenital heart defects. These are congenital conditions; therefore, they are located in Chapter 17 of ICD-10-CM. Code Q21.0 denotes a ventricular septal defect and Q21.1 denotes an atrial septal defect.
The heart also has four valves: tricuspid, mitral, pulmonary, and aortic. These valves are fibrous cusps that help the flow of blood throughout the heart by opening to permit blood flow and closing to prevent backflow of blood. The chordae tendineae are tendons made up mostly of collagen that link the papillary muscles to the tricuspid valve in the right ventricle and the mitral valve in the left ventricle. As the papillary muscles contract and relax, the chordae tendineae (sometimes called the heart strings) transmit the resulting increase and decrease in tension to the respective valves, causing them to open and close. Examples of ICD-10-CM codes for these conditions include: I34.2 Nonrheumatic mitral (valve) stenosis, I35.2 Nonrheumatic aortic (valve) stenosis and insufficiency, and I07.1 Rheumatic tricuspid insufficiency. There are also combination codes if multiple valves are diseased. For example, I08.2 Rheumatic disorders of both aortic and tricuspid valves.
This is just the "tip of the iceberg" for the cardiovascular system. In coming newsletters, we will revisit this system and delve deeper. The more you understand the structure and function of the organ systems, the more efficient and secure you will be in your coding in ICD-10-CM.
IN THE NEWS
CMS Awards Contract to Develop Process for End-to-End Testing
On September 28, 2012, CMS awarded National Government Services (NGS) with a one-year contract to develop a process and methodology for end-to-end testing of the Administrative Simplification Requirements based on industry feedback and participation. ICD-10 will be the test case used during the pilot. This process will be an industry wide "Best Practice" for End-to-End testing that lays the groundwork for a more efficient and less time consuming method for health care provider testing of future standards, leading to more rapid adoption of the future standards. CMS and NGS are looking for insights from small and large providers, vendors, and payers in the month of January through a series of listening sessions. To learn more, please visit the End-to-End testing page on the CMS website.
PREOPERATIVE DIAGNOSIS: Severe Mitral Valve Prolapse and Regurgitation
OPERATION: Mitral Valve Repair
INDICATIONS FOR SURGERY: A 50-year-old woman with a long history of mitral valve prolapse is basically asymptomatic and has severe regurgitation. She was referred for elective surgery.
OPERATIVE PROCEDURE: A small skin incision hemi-sternotomy was performed. We began by exposing the mitral valve through Sondergaard's groove. Valve analysis revealed complicated fibroelastic deficiency. She had a ballooning giant P2 segment with marked thickening and minimal P1 tissue. She also had a somewhat thickened anterior leaflet. We began by performing a limited resection of P2. We then undermined the remaining P2 segments we planned to keep and performed a limited detachment/reattachment to shorten the overall height of the remaining segments. A vertical plication was also done. The leaflets were reapproximated with a 5-0 Prolene suture. A true size 28 Physio-ring was now selected. It was tied securely to the annulus. The valve had an excellent line of symmetry, a normal saline test and a normal ink test.
POSTOPERATIVE ANALYSIS: The post-bypass transesophageal echo revealed absent residual regurgitation.
I34.0 Nonrheumatic mitral (valve) insufficiency
I34.1 Nonrheumatic mitral (valve) prolapse
Rationale: In ICD-10-CM, codes for valve disease and disorders are broken down by which valve or valves are affected, the type of disorder, and whether the condition is congenital, acquired, or rheumatic in nature. In our case study, the patient has mitral valve prolapse and regurgitation, indicating that the valve is "drooping in" and that blood is back flowing (regurgitating). The default in the Alphabetic Index in ICD-10-CM for mitral valve disorders is nonrheumatic. Unlike ICD-9-CM, ICD-10-CM has separate codes for mitral valve prolapse and mitral regurgitation; therefore, both codes are reported.
ICD-10 IMPLEMENTATION STRATEGIES
We will be sharing a number of strategies to help your practice successfully implement ICD-10-CM. Please remember to track your progress in your ICD-10 Implementation Tracker on AAPC's website.
The transition to ICD-10-CM will affect productivity on multiple levels. Documentation changes (or lack thereof) may cause delays in coding. If the provider has to be queried in order to assign a code due to lack of specificity, it will delay the claim going out for payment. Coding itself will take longer due to the number of codes and the new criteria that has to be considered when assigning ICD-10-CM codes. As we move from up to five character mostly numeric codes to up to seven character alphanumeric codes, charge entry will see productivity issues as staff will no longer be able to just use the number keypad to enter codes. What if you can no longer use an encounter form for quick diagnosis code selection? Look at your staffing, educational needs, outsourcing possibilities, and resources to assess your needs for transition. The better educated and trained everyone is, the less of a productivity hit your practice will suffer, and a quicker recovery may be realized once we implement ICD-10.
Cardiology Crosswalk - Fast Forward to ICD-10
The ICD-9 to ICD-10 crosswalk for cardiology will help you identify how the 50 most frequently used diagnostic codes for cardiology will be mapped to ICD-10. This laminated crosswalk maps from ICD-9-CM to ICD-10 and helps you see how broad diagnoses explode out to several specific diagnoses in the new system. Many other specialties, including Urology, Family Practice, and Orthopaedics are also available.