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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. © 2012 OptumInsight, Inc. 195 Comprehensive Anatomy and Physiology for ICD-10-CM and ICD-10-PCS Coding 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. 196 © 2012 OptumInsight, Inc. Comprehensive Anatomy and Physiology for ICD-10-CM and ICD-10-PCS Coding 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. 218 © 2012 OptumInsight, Inc. Comprehensive Anatomy and Physiology for ICD-10-CM and ICD-10-PCS Coding 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
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