American Heart Month is celebrated every February to encourage people to pay attention to their cardiovascular health. According to the Centers for Disease Control and Prevention (CDC), heart disease is the leading cause of death for men and women. American Heart Month provides the opportunity to reaffirm the commitment to improve the prevention, detection and treatment of heart disease. Cardiovascular disease is often called the silent killer because it can go unnoticed for a long time until a heart attack occurs.

American Heart Month was initiated in 1964 by President Lyndon B. Johnson. Launching the observance, he urged “the people of the United States to give heed to the nationwide problem of the heart and blood-vessel diseases, and to support the programs required to bring about its solution.” Though the nation has come a long way since 1964, with scientific research and evidence-based interventions playing their role to diagnose, prevent or treat heart attacks and strokes. However, despite these strides, heart disease continues to be a major public health concern and commonest cause of death in the US.

Facts about Heart Disease

Here are 4 key facts about heart disease from the CDC:

  • Heart disease is the leading cause of death for people of most racial and ethnic groups in the United States.
  • One person dies every 36 seconds in the US is caused by heart disease.
  • Heart disease costs the US about $363 billion each year from 2016 to 2017. This includes the cost of health care services, medicines, and lost productivity due to death.

There are many forms of heart disease such as coronary artery disease, heart valve disease, disease of the heart muscle, heart infection, heart rhythm problems (arrhythmias), and congenital heart defects. Various factors increase your risk for heart disease, and while some can be controlled, others cannot. Being informed is essential to lower your risk of heart disease.

Risk Factors for Heart Disease

The risk factors for heart disease include both medical conditions and lifestyle factors:

  • Hypertension or high blood pressure: High blood pressure causes hypertensive heart disease, which includes heart failure, abnormal thickening of the heart muscle, coronary artery disease, and other conditions.
  • High blood cholesterol: Atherosclerosis is a form of heart disease caused by the build-up of cholesterol in the walls of the arteries. The narrowing of the arteries that nourish the heart limit blood flow and can cause a heart attack or stroke.
  • Diabetes: High blood sugar levels damage and block the blood vessels carrying blood to and from the heart, depriving this vital organ of oxygen and nutrients. Even mildly high blood sugar levels can lead to serious complications over time.
  • Smoking: Smoking increases risk of many diseases, especially heart and lung disease. Smoking causes an instant and long-term increase blood pressure and heart rate. It reduces blood flow from the heart, reducing the amount of oxygen reaching the body’s tissues and the brain, which significantly increases the risk of stroke Smoking damages the blood vessels and increases risk for blood clots.
  • Overweight and obesity: Being overweight contributes to heart disease in many ways. Obesity can cause a spike in LDL or bad cholesterol and lower HDL or good cholesterol levels,increase blood pressure, and lead to diabetes.
  • Poor diet quality and physical inactivity: Sedentary lifestyles and unhealthy diets with high content of fats, sugar and salt substantially raise the risk of high blood pressure, diabetes and obesity, all of which are risk factors for coronary disease.
  • Excessive alcohol use: Heavy drinking can lead to obesity, high blood pressure, heart failure or stroke. Excessive alcohol use can also contribute to cardiomyopathy which affects the heart muscle and impairs the ability of the heart to pump blood.

Making lifestyle changes starting at a young age or even at an older age, is the best defense against cardiovascular disease. American Heart Month offers the ideal opportunity to motivate people the public to practice healthy habits that will minimize the modifiable risk factors for heart disease, heart attack and stroke.

Simple Strategies for a Heart-friendly Lifestyle

The American Heart Association recommends focusing on heart disease prevention early in life. To start, understand your risk factors and work to keep them low. While risk factors such as age or family history cannot be controlled, you can take steps to lower your risk by changing the factors you can control – high blood pressure, high cholesterol, and smoking.

Here are seven simple heart-healthy strategies that can provide long-term benefits for your heart and your overall health:

  • Know your numbers: Check and monitor your glucose levels, blood pressure and cholesterol. Knowing your numbers is important even if you don’t have any symptoms. Easy-to-use devices are available to do these tests at home. Without testing, there is no way of knowing if your numbers are higher than they should be. If tests reveal that your numbers are not at the accepted level, your healthcare provider can develop a plan to help you reach it.
  • Eat right: Make sure your body gets all the necessary nutrients to stay healthy. This means eating foods rich in minerals, protein, whole grains and other nutrients, but are lower in calories. To prevent heart disease, eat more vegetables and fruits, whole grains, and low-fat protein options. Reduce intake of saturated fat and trans fats to manage blood cholesterol levels. Plan a heart-healthy diet and watch portion sizes, but there’s nothing wrong in allowing yourself an occasional treat to reduce cravings.
  • Maintain a healthy weight: Sticking to a healthy weight is one of the best things you can do for your heart. Obese people require more blood to move oxygen and nutrients around in the body, which causes blood pressure to rise. Obesity also causes diabetes and high cholesterol. Even a small amount of weight loss would benefit people with risk factors for heart disease – such as high cholesterol, high blood pressure or high blood glucose. To maintain a healthy weight, eat mindfully and stay physically active and motivated. Body mass index (BMI) and waist circumference are good indicators of whether you are at a healthy weight. The American Heart Association’s recommended body mass index (BMI) range is 18.6-24.9.
  • Exercise regularly: Adults need to get at least 150 minutes per week of moderate-intensity aerobic activity or 75 minutes per week of vigorous aerobic activity, or a combination of both, preferably spread throughout the week, according to the American Heart Association. Children and teens also need to get enough exercise to maintain good health. Sit less and move more to lower your risk of heart disease.
  • Quit smoking: Quitting tobacco offers immense benefits for heart health. Cigarette smoke contains harmful chemicals, and when inhaled, damages the heart and blood vessels, and increases heart rate. According to the Food and Drug Administration (FDA), your heart rate drops minutes after you quit smoking and the carbon monoxide level in the blood returns to normal, pushing more oxygen to the heart. Within four years of quitting, an individual’s risk of stroke drops to that of people who have never smoked.
  • Manage stress: Stress is an often ignored but critical factor in heart health. “Stress can increase inflammation in your body, which in turn is linked to factors that can harm your heart, such as high blood pressure and lower “good” HDL cholesterol”, explains Johns Hopkins cardiologist Michael Blaha, M.D., M.P.H. So identify sources of stress in your life and find ways to reduce and manage them. Get professional help if necessary.
  • Get enough better sleep: Most adults need at least 7 hours of sleep each night. However, the CDC points out that more than 1 in 3 American adults say they don’t get the recommended amount of sleep. Insomnia or lack of sleep can cause health problems like diabetes, obesity and high blood pressure and impact heart health.

Diagnosis, Documentation and Coding

Various tests are used to diagnose heart disease such as electrocardiogram (ECG), echocardiogram, coronary angiography, exercise stress tests, X-rays, blood tests, radionuclide tests, and MRI and CT scans. Treatments include pharmacologic, nonpharmalogic, and surgical approaches.

It is important that clinicians document all details as ICD-10 provides specific codes for heart ailments and treatment approaches depend on the exact etiology. Accurate documentation is necessary for coders to assign the most specific codes, which is crucial for a better understanding of the care for the patient, better data collection, and reimbursement. Here are some useful documentation tips:

  • Code for all conditions that impact patient care, treatment or management.
  • Code to the highest specificity including any complications.
  • When documenting heart failure, it should be indicate whether heart failure is acute or chronic and the part of the heart that is affected.
  • If heart failure is not due to hypertension, document the cause.
  • For encounters occurring while the myocardial infarction (MI) is equal to, or less than, four weeks old, including transfers to another acute setting or a postacute setting, use the I21 code series. For old or healed myocardial infarctions that do not require further care, assign code I25.2, Old myocardial infarction.
  • Symptoms such as fatigue, edema, weight gain, etc. should be noted.
  • History of coronary artery bypass surgery, cardiac pacemaker or heart valve replacement, if any, should be documented as well as heart transplant status if the patient is awaiting transplant surgery.
  • If heart failure is not due to hypertension, separate codes should be reported for hypertension (I10) and heart failure (e.g., I50.-, I51.4-I51.9) and documented accordingly. Heart failure is assumed to be due to hypertension when coded using I11.0, “Hypertensive heart disease with heart failure.”

Common ICD-10 Codes for Cardiology:

Cardiovascular and Ischaemic Disease

125.10 Atherosclerotic heart disease of native coronary artery without angina pectoris
148.91 Unspecified Atrial Fibrillation
150.9 Congestive heart failure
I63.9 Stroke
I65.23 Occlusion and stenosis of bilateral carotid arteries
I65.29 Occlusion and stenosis of unspecified carotid artery
I67.2 Cerebral atherosclerosis
167.9 Cerebrovascular disease, unspecified
173.9 Peripheral Vascular Disease

Circulatory System Diseases

I5A non-ischemic myocardial injury (non-traumatic) – new in 2022
I20.9 Angina pectoris, NOS
I21.09 Acute heart attack, anterior wall
121.3 Acute myocardial infarction of unspecified site
I25.10 Atherosclerotic heart disease of native coronary artery without angina pectoris
125.9 Chronic ischemic heart disease, unspecified

Hypertentive Disease

I10 Essential (primary) hypertension
110 Benign Hypertension
111.0 Malignant hypertensive heart disease with congestive heart failure
111.0 Hypertensive heart and kidney disease
111.0 Hypertensive heart failure
I11.9 Hypertensive heart disease without heart failure
111.9 Benign hypertensive heart disease
111.9 Cardiomyopathy due to hypertension

Metabolic and Nutritional Diseases

E11.65 Type 2 diabetes mellitus with hyperglycemia
Type 2 diabetes mellitus without complications
E55.9 Vitamin D deficiency, unspecified
E78.0 Pure hypercholesterolemia
E78.00 Pure hypertriglyceridemia, unspecified
E78.01 Familial hypercholesterolemia
E78.2 Mixed hyperlipidemia
E78.5 Hyperlipidemia unspecified
E88.81 Metabolic syndrome
E88.81 Dysmetabolic syndrome
E88.81 Insulin resistance

Abnormal Glucose

R73.01 Impaired fasting glucose
R73.01 Abnormal glucose NOS
R73.01 Abnormal non-fasting glucose tolerance
R73.09 Other abnormal glucose
R73.09 Abnormal glucose NOS
R73.09 Abnormal non-fasting glucose tolerance
R73.9 Hyperglycemia

Physicians can rely on a cardiology medical billing and coding company to assign the right codes to report their services on claims.

Recognizing the Signs of a Heart Attack

As the nation works towards the eradication of heart disease and stroke, it is important that everyone recognizes the early signs and symptoms.

In a proclamation on American Heart Month 2021, US President Joe Biden stated, “We have seen the death rate from heart attacks rise dramatically during the COVID-19 pandemic because people are delaying or not seeking care after experiencing symptoms. It is important not to ignore early warning signs like chest pain, palpitations, shortness of breath, and sudden dizziness”. (Swollen legs, ankles or feet, fatigue and unexplained aches and pains are other signs to watch out for.

The symptoms of a heart attack can be different for men and women, and knowing these differences can have an impact when people seek care. While chest pain or discomfort are common in both men and women, symptoms in women may include shortness of breath, nausea/vomiting and back or jaw pain. New research led by Edith Cowan University has found that the build-up of calcium in a major artery outside of the heart could predict future heart attack or stroke (www.eurelalert.com). Published in the Journal of the American Heart Association in January 2021, the study could help physicians identify people at risk of cardiovascular disease years before symptoms arise.

Celebrate American Heart Month – build awareness about heart health and play your part to preserve the nation’s cardiovascular health now and into the future.