IHEU unique 7/13/06 12:03 PM Page i 2007 ICD-9-CM Expert for Hospitals Volumes 1, 2 & 3 International Classification of Diseases 9th Revision Clinical Modification Sixth Edition Edited by: Anita C. Hart, RHIA, CCS, CCS-P Beth Ford, RHIT, CCS Ingenix is committed to providing you with the ICD-9-CM code update information you need to code accurately and to be in compliance with HIPAA regulations. In the case of adoption of additional ICD-9-CM code changes effective April 1, 2007, Ingenix will provide these code changes to you at no additional cost! Just check back at http://www.IngenixOnline.com and look for the ICD-9, CPT® and HCPCS Alerts link under the Quick Access Resources menu to review the latest information concerning any new code changes. Codes Valid October 1, 2006, through September 30, 2007 October 2006 Update 3539/IHEU/U0515 07 ICD9 v1 H 7/11/06 2:24 PM Page 127 Tabular List CIRCULATORY SYSTEM 425.8–426.89 Circulatory System 425.8–426.89 Nerve Conduction of the Heart Normal and Long QT Electrocardiogram QRS Interval ST Interval Normal Long QT R Syndrome R PR Sinoatrial node Segment QT Interval QT Interval (pacemaker) Bachmannʼs bundle PR ST Interval Segment Internodal tracts: Anterior T Middle P T P Posterior Left bundle branch block Left bundle branch: Atrioventricular Q node Anterior fascicle Q Common bundle Posterior fascicle S (of His) S Left bundle branch Atrioventricular block hemiblock 0.2.4.6 0.2.4.6 Accessory bundle MC (of Kent) 426.3 ¥>Other left bundle branch block Right bundle branch Left bundle branch block: Right bundle branch block NOS Moderator band Purkinje fibers anterior fascicular with posterior fascicular complete 425.8 <¥>Cardiomyopathy in other diseases classified CC CD main stem ¥>elsewhere Code first underlying disease, as: 426.4 ¥>Right bundle branch block Friedreich’s ataxia (334.0) AHA: 3Q, ‘00, 3 myotonia atrophica (359.2) k 426.5 Bundle branch block, other and unspecified progressive muscular dystrophy (359.1) 426.50 Bundle branch block, unspecified sarcoidosis (135) <¥> 426.51 Right bundle branch block and left MC EXCLUDES cardiomyopathy in Chagas’ disease posterior fascicular block (086.0) 426.52 Right bundle branch block and left MC CC Excl: See code 425.0 anterior fascicular block AHA: 2Q, ‘93, 9 11 426.53 Other bilateral bundle branch CC MC MCV 425.9 Secondary cardiomyopathy, unspecified CC CD block CC Excl: See code 425.0 Bifascicular block NOS Bilateral bundle branch block NOS ' 426 Conduction disorders Right bundle branch with left bundle DEF: Disruption or disturbance in the electrical impulses that regulate branch block (incomplete) (main stem) heartbeats. CC Excl: See code 426.0 11 CC MC MCV 426.0 Atrioventricular block, complete 11 426.54 Trifascicular block CC MC MCV Third degree atrioventricular block CC Excl: See code 426.0 CC Excl: 426.0-427.5, 427.89, 459.89, 459.9 CC k 426.6 Other heart block 426.1 Atrioventricular block, other and unspecified Intraventricular block: Sinoatrial block 426.10 Atrioventricular block, unspecified MC NOS Sinoauricular block Atrioventricular [AV] block (incomplete) diffuse (partial) myofibrillar 426.11 First degree atrioventricular block CC Excl: See code 426.0 Incomplete atrioventricular block, first degree Prolonged P-R interval NOS 426.7 Anomalous atrioventricular excitation CC 426.12 Mobitz (type) II atrioventricular CC MC Atrioventricular conduction: block accelerated Incomplete atrioventricular block: accessory Mobitz (type) II pre-excitation second degree, Mobitz (type) II Ventricular pre-excitation CC Excl: See code 426.0 Wolff-Parkinson-White syndrome CC Excl: See code 426.0 DEF: Impaired conduction of excitatory impulse from cardiac atrium to ventricle through AV node. DEF: Wolff-Parkinson-White: normal conduction pathway is 426.13 Other second degree atrioventricular CC MC bypassed; results in short P-R interval on EKG; tendency to block supraventricular tachycardia. Incomplete atrioventricular block: k 426.8 Other specified conduction disorders Mobitz (type) I [Wenckebach’s] 426.81 Lown-Ganong-Levine syndrome CC second degree: Syndrome of short P-R interval, normal QRS NOS complexes, and supraventricular Mobitz (type) I tachycardias with 2:1 atrioventricular response [block] CC Excl: See code 426.0 Wenckebach’s phenomenon 426.82 Long QT syndrome CC Excl: See code 426.0 AHA: 4Q, ’05, 72 DEF: Wenckebach’s phenomenon: impulses generated at constant rate to sinus node, P-R interval lengthens; DEF: Condition characterized by recurrent syncope, results in cycle of ventricular inadequacy and shortened malignant arrhythmias, and sudden death; characteristic P-R interval; second-degree A-V block commonly called prolonged Q-T interval on electrocardiogram. "Mobitz type 1.” 426.89 Other CC 426.2 <¥>Left bundle branch hemiblock Dissociation: Block: atrioventricular [AV] left anterior fascicular interference left posterior fascicular isorhythmic Nonparoxysmal AV nodal tachycardia CC Excl: See code 426.0 11 MCV for DRGs 547, 549, 553, 555, and 557 only. ' MCV wx l s k Additional Digit Required Nonspecific PDx Unacceptable PDx Manifestation Code Major Cardiovascular Condition Revised Text New Code Revised Code Title 2007 ICD•9•CM October 2006 • Volume 1 — 127 07 ICDv3 H 7/11/06 3:50 PM Page 112 37.83–37.98 OPERATIONS ON THE CARDIOVASCULAR SYSTEM Tabular List Insertion of Pacemaker Automatic Implantable Cardioverter/Defibrillator Subclavian Intravascular Lead vein electrode leads in Pulse subclavian vein generator (pacemaker) in subcutaneous pocket Pulse generator Pacing electrode lead Electrode Defibrillation electrode lead 17 37.83 <¥>Initial insertion of dual-chamber device 37.92 Injection of therapeutic substance into heart Atrial ventricular sequential device 37.93 Injection of therapeutic substance into EXCLUDES replacement of existing pericardium pacemaker device 37.94 Implantation or replacement of automatic (37.85-37.87) ¥> AHA: 2Q, ‘97, 4 ¥>cardioverter/defibrillator, total system ¥>[AICD] 37.85 ¥>Replacement of any type pacemaker device wNote: Device testing during procedure— ¥>with single-chamber device, not specified as omit codex ¥>rate responsive Implantation of defibrillator with leads 37.86 ¥>Replacement of any type pacemaker device (epicardial patches), formation of pocket (abdominal fascia) (subcutan- ¥>with single-chamber device, rate responsive Rate responsive to physiologic stimuli other eous), any transvenous leads, intra- than atrial rate operative procedures for evaluation of lead signals, and obtaining 37.87 ¥>Replacement of any type pacemaker device defibrillator threshold measurements ¥>with dual-chamber device Techniques: Atrial ventricular sequential device lateral thoracotomy 37.89 ¥>Revision or removal of pacemaker device medial sternotomy Removal without replacement of cardiac re- subxiphoid procedure synchronization pacemaker device Code also extracorporeal circulation, if [CRT-P] performed (39.61) Repair of pacemaker device Code also any concomitant procedure [e.g., EXCLUDES removal of temporary trans- coronary bypass] (36.01-36.19) venous pacemaker EXCLUDES implantation of cardiac resyn- system — omit code chronization defibrillator, replacement of existing pacema- total system [CRT-D] ker device (37.85-37.87) (00.51) replacement of existing pace- AHA: 2Q, ‘03, 19; 3Q, ‘01, 5-7; 3Q, ‘99, 12; 1Q, ‘99, 3; maker device with CRT-P 3Q, ‘90, 11; S-O, ‘87, 5 37.83–37.98 Operations on the Cardiovascular System pacemaker device (00.53) DEF: Direct insertion, of defibrillator/cardioverter system AHA: N-D, ‘86, 1 to deliver shock and restore heart rhythm. ' 37.9 Other operations on heart and pericardium 37.95 ¥>Implantation of automatic AHA: 3Q, ‘90, 11 ¥>cardioverter/defibrillator lead(s) only AHA: 3Q, ‘90, 11 37.90 <¥>Insertion of left atrial appendage device Left atrial filter Transseptal catheter 37.96 ¥>Implantation of automatic cardioverter/ Left atrial occluder technique ¥>defibrillator pulse generator only AHA: 4Q, ’04, 121 wNote: Device testing during procedure— DEF: Implantation of a filtering device within the left omit codex atrial appendage (LAA) to block emboli from exiting the EXCLUDES implantation or replacement of LAA causing stroke or systemic thromboembolism. cardiac resynchron- ization defibrillator, pulse 37.91 ¥>Open chest cardiac massage generator device only EXCLUDES closed chest cardiac massage [CRT-D] (00.54) (99.63) AHA: 3Q, ‘90, 11 AHA: 4Q, ‘88, 12 DEF: Massage of heart through opening in chest wall to 37.97 ¥>Replacement of automatic reinstate or maintain circulation. ¥>cardioverter/defibrillator lead(s) only EXCLUDES w replacement of epicardial lead Left Atrial Appendage Device Insertion [electrode] into Left atrial Left epicardium (37.74) appendage atrium replacement of transvenous lead [electrode] into left ventricular coronary venous system (00.52)x AHA: 3Q, ’05, 3-9; 3Q, ‘90, 11 Right 37.98 <¥>Replacement of automatic cardioverter atrium ¥>defibrillator pulse generator only wNote: Device testing during procedure— omit codex EXCLUDES replacement of cardiac resyn- Delivery Device chronization defibrillator, catheter implanted pulse generator device in left atrial only [CRT-D] (00.54) appendage AHA: 1Q, ‘99, 3; 3Q, ‘90, 11 17 Valid OR procedure code if accompanied by one of the following codes: 37.70, 37.71, 37.73, 37.76 BI Bilateral ProcedureNC Non-covered ProcedureLC Limited Coverage Procedure wx Revised Text l New Code s Revised Code Title 112 — Volume 3 • October 2006 2007 ICD•9•CM IHEU IHES IHP Front Matter 7/13/06 12:02 PM Page xvi Summary of AHA’s Coding Clinic for ICD-9-CM Topics The following overview of topics represents a brief summary of the topics Dural Tear/ Postoperative Pseudomeningocele presented in AHA’s Coding Clinic for ICD-9-CM, first quarter 2006. Please refer Pseudomeningocele is a postoperative complication that occurs secondarily to to the Coding Clinic for the full discussion, including the coding question, a dural tear that was a result of spinal disc or spinal stenosis surgery, coding scenarios, and official advice. traumatic injury, or tumor removal. Assign the code for central nervous system complication and an additional code for disorders of the meninges to Bilateral Carotid Artery Stenosis further describe the pseudomeningocele.