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Carotid US dx coding

  1. #1
    Greeley, Colorado
    Default Carotid US dx coding
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    Would anyone code 433.10 if "mild bilateral plaque" is the only finding? I say NO but need a resource if I am correct, so I can prove it...
    Lisa Bledsoe, CPC, CPMA

  2. Default
    No Lisa , it is a pathological finding. I am afraid there are much more literatures to show that it is not normal than to prove it is not significant.( that too with US alone)
    However, presence of plague- atherosclerotic plagues – is not a normal phenomenon in carotid vessel be it mild or moderate or severe. Plaque morphology and the character( quality) is more significant than the least amount or quantity of the plague which is responsible for plague instability which is the determining factor to produce cerebral symptoms.
    Increased Internal carotid artery Peak systolic Velosity is associated with presence of atherosclerotic plague instability independent of degree of ICA stenosis. This is studied by Doppler than the regular US. More than that, the arteriography is the gold standard to predict.
    So mild or moderate it is a pathology and it should be reported.

    Thank you for tuning in!

  3. #3
    Greeley, Colorado
    What about "trace regurgitation" on echos?

    I just don't see it as appropriate to give a patient a code for a disease like mitral regurgitation or carotid artery stenosis if it is not a significant finding.

    Any other opinions?
    Lisa Bledsoe, CPC, CPMA

  4. Default
    That is what medicine is. When it is documented with some dicease name, we better not ignore.
    For some diseases asymptomic are also significant; one among them is Mitral Regurgitation.

    Mitral valve regurgitation otherwise known as M. insufficiency is the abnormal leaking of blood thro ( a back flow), the mitral valve, from the left ventricle into the left atrium of the heart.
    The degree of severity of MI can be quantified by the percentage of the left vent stroke volume that regurgitates into the left atrium (ie the regurgitation fraction.)
    The terms classified are such as: mild, moderate ,mod to severe, severe .( I haven’t heard of TRACE; may be the mild. So far not classified so).
    The regurgitant fraction and the associated signs of hemodynamic compromise are the determinants for treatment modalities. This is apart- be it symptomatic or asymptomatic

    However, any abnormality- trace or mild (20% RF) , moderate(20-40%RF) , mod-severe(40-60%RF) or severe (more than 60% RF) is a mitral lesion and not acceptable to ignore; so also for coding
    As for my opinion, trace should be placed at mild variety but not as normal.
    ICD -9 394.1 ( rhematic), 424.0-non rheumatic), 746.6-congenital).
    Well as you said, you better would wait for some expert to place their opinion. Thank you

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