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Like many other medical specialties, cardiology is also facing coding and reimbursement changes in 2019. While outsourcing cardiology coding to an experienced medical billing and coding company can ensure accurate claim submission and optimal reimbursement, hospitals and surgery centers need to stay up to date on these changes.

For cardiology, ICD-10 generally focuses on increased specificity to describe the patient’s condition. The changes for cardiovascular and cardiothoracic services in 2019 are as follows:

  • Updates for Cerebral Infarction Additions: The following code additions have been made to the Cerebral Infarction category (category I63):
    • I63.81 – Other cerebral infarction due to occlusion or stenosis of small artery (this code also covers lacunar infarction)
    • I63.89 – Other cerebral infarction

    R29.7 – ICD-10-CM code for the National Institute of Health Stroke Scale (NIHSS) on patients diagnosed with a stroke can be reported in conjunction with acute stroke codes (I63) to identify the patient’s neurological status and the severity of the stroke. The stroke scale codes should be sequenced after the acute stroke diagnosis code(s). At a minimum, the initial score documented should be reported. Multiple stroke scale scores can also be captured if required.

    Note: An instructional note under category I63- instructs that an additional code be reported, if applicable, to identify status post administration of tPA (rtPA) in a different facility with the last 24 hours prior to the patient’s admission to the current facility (Z92.82).

    Revisions: There are changes to the descriptors for 219 and 239, where the word arteries has been changed to artery:

    • I63.219 (Cerebral infarction due to unspecified occlusion or stenosis of unspecified vertebral artery) and
    • I63.239 (… unspecified carotid artery). In both descriptors, the current word “arteries” has changed to “artery.”

    There are also revisions to the descriptors for the following codes with the addition of the word ‘due’:

    • I63.333 (Cerebral infarction due to thrombosis of bilateral posterior cerebral arteries)
    • I63.343 (Cerebral infarction due to thrombosis of bilateral cerebellar arteries).
  • New Subcategory for Category I67Category I67 (Other cerebrovascular disease) now has a new subcategory I67.85 – for hereditary cerebrovascular diseases. This subcategory includes the following news codes:
    • I67.850 – Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL is also included with this diagnosis)
    • I67.858 – Other types of hereditary cerebrovascular disease

    Under I67.850 i.e. other cerebrovascular diseases there’s a new code which instructs you to report any associated diagnoses. This includes epilepsy and recurrent seizures G40 -; cerebral infarction I63.-; and vascular dementia F01.-.

    Note: A new “code also” note under I67.850 (Other cerebrovascular diseases) instructs also reporting any associated diagnoses such as epilepsy and recurrent seizures (G40.-); cerebral infarction (I63.-); and vascular dementia (F01.-).

  • Other Cardiology Code Revisions
    • I22.8 Subsequent posterior true transmural Q wave myocardial infarction
    • 197.64 – Postproc seroma of a circ system org fola a circ sys procedure
    • T46.4X Angiotensin-converting-enzyme inhibitors
    • T81.11 Post-procedural cardiogenic shock
    • T81.11XA Post-procedural cardiogenic shock, initial encounter
    • T81.11XD Post-procedural cardiogenic shock, subsequent encounter
    • T81.11XS Post-procedural cardiogenic shock, the sequel
    • T46.4X Angiotensin-converting-enzyme
  • New Guidelines to Code Hypertension with Heart DiseaseMedical coding service providers also need to note the changes in official guidelines on coding hypertension with heart disease and pulmonary hypertension. A report in explains these new 2019 guidelines as follows:
    • Coding hypertension with heart disease: In 2018, section I.C.9.a.1 of the official guidelines (Hypertension with Heart Disease) stated that “Hypertension with heart conditions classified to I50.- or I51.4-I51.9 are assigned to a code from category I11, Hypertensive heart disease.”In the 2019, the guidelines change the code listing to “I50.- or I51.4-I51.7, I51.89, I51.9.” Additional code(s) from category I50.- (Heart failure) will continue to be used to identify the heart failure type, when applicable, but in 2019, I51.81 (Takotsubo syndrome) has been removed from the guideline.
    • There is an additional clarification for the instruction in the Hypertension with Heart Disease subsection about when to code those heart conditions separately from the hypertension. The wording has changed in 2019 as follows:2018: “if the provider has specifically documented a different cause”
      2019: “if the provider has documented they are unrelated to the hypertension.”
    • The wording for the Hypertensive Chronic Kidney Disease subsection also sees a change:2018: “CKD should not be coded as hypertensive if the physician has specifically documented a different cause.”
      2019: “CKD should not be coded as hypertensive if the provider indicates the CKD is not related to the hypertension.”
  • Changes for Pulmonary HypertensionCoders should also become familiar with the redefined sequencing rules for pulmonary hypertension in 2019.2018: For secondary pulmonary hypertension, the guideline stated that you should “code also” associated conditions or adverse effects of drugs or toxins and base the sequencing on the reason for the encounter.2019: The instruction to base sequencing on the reason for the encounter “except for adverse effects of drugs (section I.C.19.e)” has been revised. The section referenced covers coding for Adverse Effects, Poisoning, Underdosing, and Toxic Effects.
  • Acute myocardial infarction (AMI) interventionsThe 2019 guidelines expand clarifications on how to code properly for AMI. A new instruction states, “If a subsequent myocardial infarction of one type occurs within 4 weeks of a myocardial infarction of a different type, assign the appropriate codes from category I21 [Acute myocardial infarction] to identify each type. Do not assign a code from I22 [Subsequent ST elevation (STEMI) and non-ST elevation (NSTEMI) myocardial infarction].”The guidelines also clarify that, “Codes from category I22 should only be assigned if both the initial and subsequent myocardial infarctions are type 1 or unspecified.”

The best option for cardiologists to ensure compliance with the new coding guidelines and receive the maximum reimbursement for their services is to outsource coding and billing to an experienced cardiology medical coding company.

Natalie Tornese

Holding a CPC certification from the American Academy of Professional Coders (AAPC), Natalie is a seasoned professional actively managing medical billing, medical coding, verification, and authorization services at OSI.

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