07 TAP Cardio.Fm

Chapter 7. Cardiovascular System

The increased specificity of ICD-10-CM makes it imperative that physicians document more detailed information and that coders are able to determine from documentation the code or codes appropriate for the patient’s condition.

Valvular Disorders Acute rheumatic fever, a complication of strep pharyngitis in children, results in various cardiac conditions in more than a third of patients affected. Depending on the extent of heart inflammation involved, patients with the acute form of  DEFINITIONS the disease may develop heart failure, pericarditis, myocarditis, and endocarditis, which is manifested as insufficiency of the mitral (65 to 70 percent of cases) and pericarditis. Inflammation affecting aortic valves (25 percent of cases). the pericardium.

Figure 7.11: Valvular Function

Chronic disease may result in arrhythmias, ventricular dysfunction, and dilation of the atria. In adults, acute rheumatic fever is the most common cause of mitral valve stenosis and the leading cause for valvular replacement surgery. Although the mitral valve is most commonly affected, the aortic and tricuspid valves may also be involved. Chronic manifestations due to protracted disease and continued valve deformity occur in an estimated 9 to 39 percent of adults with previous rheumatic heart disease. Two to 10 years after an acute episode of rheumatic fever, the valve apparatus may fuse, with resulting stenosis or stenosis with insufficiency. Each recurrent episode can extend the valvular damage. For acute rheumatic heart conditions, there is a one-to-one mapping of the appropriate ICD-9-CM code to the appropriate ICD-10-CM code. For instance, ICD-9-CM code 391.0 for acute rheumatic pericarditis directly correlates to code IØ1.1 in ICD-10-CM. This is also true for some valvular diseases resulting from rheumatic fever. Although ICD-9-CM does classify some conditions as rheumatic in nature, ICD-10-CM has distinguished, in large part, specific valvular diseases caused by rheumatic fever versus those not related to the disease, as well as the specific valve involved as shown in the following table. This differentiation does not always result in additional ICD-10-CM codes, as demonstrated by ICD-9-CM codes 396.0 through 396.8, which map to ICD-10-CM code IØ8.Ø.

Coding for Diseases of the Heart Valves

ICD-9-CM ICD-10-CM Rheumatic 394.0 Mitral stenosis I05.0 Rheumatic mitral stenosis 394.2 Mitral stenosis with I05.2 Rheumatic mitral stenosis with insufficiency insufficiency 394.9 Other and unspecified mitral I05.8 Other rheumatic mitral valve diseases valve diseases I05.9 Rheumatic mitral valve disease, unspecified 396.0 Mitral valve stenosis and aortic I08.0 Rheumatic disorders of both mitral and aortic valve stenosis valves 396.1 Mitral valve stenosis and aortic I08.0 Rheumatic disorders of both mitral and aortic valve insufficiency valves 396.2 Mitral valve insufficiency and aortic valve stenosis 396.3 Mitral valve insufficiency and aortic valve insufficiency 397.0 Diseases of tricuspid valve I07.0 Rheumatic tricuspid stenosis I07.1 Rheumatic tricuspid insufficiency I07.2 Rheumatic tricuspid stenosis and insufficiency I07.8 Other rheumatic tricuspid valve diseases I07.9 Rheumatic tricuspid valve disease, unspecified 397.1 Rheumatic diseases of I09.89 Other specified rheumatic heart diseases pulmonary valve 397.9 Rheumatic diseases I08.1 Rheumatic disorders of both mitral and endocardium valve tricuspid valves unspecified I08.2 Rheumatic disorders of both aortic and tricuspid valves I08.3 Combined rheumatic disorders of mitral, aortic, and tricuspid valves I08.8 Other rheumatic multiple valve diseases I08.9 Rheumatic multiple valve disease, unspecified I09.1 Rheumatic diseases of endocardium, valve unspecified

There are many differences between the ICD-9-CM and ICD-10-CM terminology used for valvular disorders. Key differences can be as simple as a “disorder” code in ICD-9-CM becoming more specific in ICD-10-CM; however, there are some important terms to be aware of. Insufficiency is, in general, the inability to perform a function adequately or to  DEFINITIONS the level necessary for the human body. When using the term with regard to valve function, it typically means the valve isn’t functioning as well as it should insufficiency. Inadequate closure of be, allowing blood to flow back into the chamber inappropriately. the valve, allowing abnormal backward blood flow. Prolapse, specifically mitral valve prolapse, occurs when the cusps of the mitral regurgitation. Abnormal backward valve protrude into the left atrium during ventricular systole. It is sometimes flow. referred to as mitral valve prolapse syndrome. stenosis. Narrowing or constriction of a passage. Stenosis means narrowing or contracted. Regarding the valves, it describes a condition in which there has been a narrowing or a stricture caused by a multitude of factors, such as calcification or a congenital malformation. Understanding these three terms helps when reporting valve disorders in ICD-10-CM. It is not known how payers will handle unspecified codes under the ICD-10-CM code set, so it is important to always code to the highest level of specificity. This may mean querying the provider for additional information.

Intracerebral hemorrhage accounts for 10 to 15 percent of all strokes. This type  DEFINITIONS of stroke is associated with a much higher rate of mortality than that of the more common acute ischemic stroke, caused by thrombosis or embolism. aphasia. Partial or total loss of the ability to comprehend language or Intracerebral hemorrhages (nontraumatic) are classified to category 430 in communicate through speaking, the ICD-9-CM, and traumatic hemorrhages are classified to category 851, written word, or sign language. Aphasia may result from stroke, regardless of where the bleeding occurs in the brain. ICD-10-CM classifies injury, Alzheimer's disease, or other intracerebral hemorrhages according to whether the bleed was traumatic or disorder. Common types of aphasia nontraumatic, but also designates the specific part of the brain in which the include expressive, receptive, bleed occurred for nontraumatic bleeds. anomic, global, and conduction. apraxia. Impaired sequencing of Coding for Intracerebral Hemorrhage motor skills. Apraxia can be used to describe a variety of symptoms, from ICD-9-CM ICD-10-CM an awkward gait to anomalous speech. 431 Intracerebral hemorrhage I61.0 Nontraumatic intracerebral hemorrhage in ataxia. Defect in muscular hemisphere, subcortical coordination, seen especially when I61.1 Nontraumatic intracerebral hemorrhage in voluntary muscular movements are hemisphere, cortical attempted. I61.2 Nontraumatic intracerebral hemorrhage in hemisphere, unspecified cognitive. Having to do with being aware by drawing from knowledge, I61.3 Nontraumatic intracerebral hemorrhage in such as judgment, reason, brain stem perception, and memory. I61.4 Nontraumatic intracerebral hemorrhage in cerebellum cortical. Pertaining to the cortex, I61.5 Nontraumatic intracerebral hemorrhage, which is the outer portion of an intraventricular organ. In the brain it refers to the outer part of the cerebrum. I61.6 Nontraumatic intracerebral hemorrhage, multiple localized dysarthria. Difficulty pronouncing I61.8 Other nontraumatic intracerebral hemorrhage words. I61.9 Nontraumatic intracerebral hemorrhage, dysphagia. Difficulty and pain upon unspecified swallowing. Common causes of dysphagia are esophagitis, Barrett's esophagus, or late effect of a stroke. Residual Effects of Cerebrovascular Disease hemianopsia. Loss of partial vision When a brain injury occurs due to a stroke or other type of cerebrovascular or complete blindness in half of the disease or due to a traumatic injury to the brain, residual effects can occur visual field of one (unilateral according to the severity and the site of the brain injury. This includes paralysis; hemianopsia) or both (bilateral speech and language problems, such as aphasia, dysarthria, and dysphasia; and hemianopsia) eyes. cognitive defects. For both coding classification systems, these residual hemiplegia. Paralysis of one side of neurological deficits are reported in addition to the underlying brain injury code the body. regardless of when the deficit occurs. Once again, ICD-10-CM classifies these monoplegia. Loss or impairment of motor function in one arm or one conditions with greater specificity, including hemiplegia and monoplegia for leg. which ICD-10-CM indicates if the left or right side or limb is dominant. subcortical. Pertaining to the part of ICD-9-CM simply refers to the dominant side, with no distinction between the brain below the cebral cortex. right and left. Speech deficits are also classified in much more detail in ICD-10-CM, specifying the underlying cause of the condition, as indicated in the following table.

Central Nervous System (0) Procedures involving the central nervous system can cover a variety of areas and a number of different types of procedures, such as nerve transfers and mapping procedures. A compiled table for body system character 0 Central Nervous System shows all of the valid characters for that system under ICD-10-PCS.

Operation–Character 3 Body Part–Character 4 Approach–Character 5 Device–Character 6 Qualifier–Character 7 1 Bypass 0 Brain 0 Open 0 Drainage Device 0 Nasopharynx 2 Change 1 Cerebral Meninges 3 Percutaneous 2 Monitoring Device 1 Mastoid Sinus 5 Destruction 2 Dura Mater 4 Percutaneous Endoscopic 3 Infusion Device 2 Atrium 8 Division 3 Epidural Space X External 7 Autologous Tissue 3 Blood Vessel Substitute 9 Drainage 4 Subdural Space J Synthetic Substitute 4 Pleural Cavity B Excision 5 Subarachnoid Space K Nonautologous Tissue 5 Intestine Substitute C Extirpation 6 Cerebral Ventricle M Electrode 6 Peritoneal Cavity D Extraction 7 Cerebral Hemisphere Y Other Device 7 Urinary Tract F Fragmentation 8 Basal Ganglia Z No Device 8 Bone Marrow H Insertion 9 Thalamus 9 Fallopian Tube J Inspection A Hypothalamus B Cerebral Cisterns K Map B Pons F Olfactory Nerve N Release C Cerebellum G Optic Nerve P Removal D Medulla Oblongata H Oculomotor Nerve Q Repair E Cranial Nerve J Trochlear Nerve S Reposition F Olfactory Nerve K Trigeminal Nerve T Resection G Optic Nerve L Abducens Nerve U Supplement H Oculomotor Nerve M Facial Nerve W Revision J Trochlear Nerve N Acoustic Nerve X Transfer K Trigeminal Nerve P Glossopharyngeal Nerve L Abducens Nerve Q Vagus Nerve M Facial Nerve R Accessory Nerve N Acoustic Nerve S Hypoglossal Nerve P Glossopharyngeal Nerve X Diagnostic Q Vagus Nerve Z No Qualifier R Accessory Nerve S Hypoglossal Nerve T Spinal Meninges U Spinal Canal V Spinal Cord WCervical Spinal Cord X Thoracic Spinal Cord Y Lumbar Spinal Cord

This table provides a great basis from which to study important terminology concerning the central nervous system, as well as terms used throughout ICD-10-PCS in general.

Root Operation — Character 3 The root operation character is one of the first key decisions required in the ICD-10-PCS coding process. Understanding the meanings of the various root operations is vital to code selection. Each body system has its own list of appropriate root operations. The characters are consistent across all body systems in the medical and surgical section of ICD-10-PCS, but not all root operation characters are used in all tables. Refer to Appendix C for the full definition of all root operations in ICD-10-PCS. The root operations used in the central nervous system table are as follows:

Root Operation Character Value Root Operation Character Value

Bypass 1 Inspection J Change 2 Map K Destruction 5 Release N Division 8 Removal P Drainage 9 Repair Q Excision B Reposition S Extirpation C Resection T Extraction D Supplement U Fragmentation F Revision W Insertion H Transfer X

The terms used in ICD-10-PCS may not be the terms used in documentation by the providers. A good example of this is the root operation extirpation, a term not familiar to many coders. Extirpation is the removal of solid matter from a body part, oftentimes a tubular body part, although that is not required. This term may not be found in the operative report. However, knowledge and understanding of the PCS definition of this term is required for accuracy in assignment of the most appropriate ICD-10-PCS code.

Body Part — Character 4 The body part characters in ICD-10-PCS detail the specific site where the procedure was performed. Again, the physician may use different terminology than is used in the table, so it is vital to understand not only the term as given in the table but also associated terms.

Figure 14.1: Brain Sections

Thalamus 9 Choroid plexus 6 Cerebrum 0 Basal ganglia 8 Hypothalamus A Third ventricle 6

Cerebral Subarachnoid Pons aqueduct 6 space 5 B Cerebellum C Choroid plexus 6 Dura mater 2 Fourth ventricle 6 Medulla oblongata D Spinal cord V

Character Value – 0, Brain Associated Terms: Cerebrum, Corpus callosum, Encephalon The cerebrum is the large uppermost section of the brain, which is divided into two hemispheres. The corpus callosum is the band of nerve fibers that joins the two cerebral hemispheres together. Encephalon is a term that is used to refer to all of the contents of the cranium, such as the cerebrum, the cerebellum, and the other structures of the brain.

Character Value – 1, Cerebral Meninges Associated Terms: Arachnoid mater, Leptomeninges, Pia mater The meninges are the membranes that enclose the brain and the spinal cord, and the cerebral meninges are those that specifically enclose the cerebrum. The arachnoid membrane or mater/sheath lies between the dura mater and the pia mater to help protect the brain. The pia mater is the inner most layer of membrane helping to protect the brain. This membrane layer is rich in blood vessels to help supply the nervous tissue. The leptomeninges is a term used to describe both the pia mater and the arachnoid membrane in combination with one another.

Character Value — 2, Dura Mater Associated Terms: Cranial dura mater, denticulate ligament, diaphragma sellae, falx cerebri, spinal dura mater, tentorium cerebelli The dura mater is the outermost membrane of those that enclose the brain and spinal cord. The denticulate ligaments are “tooth-like” portions of ligament that attach the pia mater to the dura mater and arachnoid membranes, and are known to give some stability to the spinal cord with the vertebral column. Several of these terms are different types of dura mater. The diaphragma sellae is the portion of the dura mater that creates a partition between the pituitary gland and the brain above. The falx cerebri is a sickle-shaped fold of the dura mater that extends into the fissure between the two hemispheres of the cerebrum. The tentorium cerebelli is a horizontal projection of the meningeal dura mater that separates the cerebellum in the posterior cranial fossa from the posterior portion of the cerebral hemispheres.