Cardiovascular disease (CVD) is an umbrella term used for a group of disorders that affect the heart, blood vessels or both. CVDs are among the most serious disorders affecting Americans. The latest statistics indicate that about 48 percent of all adults in the United States have some form of cardiovascular disease. Proper documentation is necessary to justify medical necessity and selection of codes for billing. Relying on a reliable cardiology medical billing company can help in accurate and timely claim submission for appropriate reimbursement.

Reports suggest that CVDs accounted for 840,678 deaths in the United States in 2016, approximately 1 out of every 3 deaths. The condition is expected to claim more lives each year than all forms of cancer and chronic lower respiratory diseases combined. CVDs occur due to the damage to all or part of the heart, damage to the coronary arteries, or a poor supply of nutrients and oxygen to the organ. Some types of cardiac diseases are genetic.

There are different types of heart diseases that affect various parts of the organ and occur in different ways. Symptoms will usually vary, depending on the specific type of disease a person suffers from. Common symptoms include – chest pain, breathlessness, and heart palpitations. The lifetime risk of developing CVDs is about 50 percent more for both men and women. Potential risk factors include – physical inactivity, unhealthy diet, high blood pressure and cholesterol, smoking, lack of sleep and alcohol consumption. Identifying these risk factors early and ensuring proper treatment can prevent premature deaths.

Treatment of CVD depends on the type of condition and generally includes medications, lifestyle modifications, cardiac rehabilitation (including exercise and counseling), and surgery (in severe cases). Physician practices treating patients with different types of cardiovascular diseases (CVDs) need to know the ICD-10 codes to report these conditions correctly. Let’s take a look at the ICD-10 codes for five common cardiovascular diseases:

Congenital heart disease (CHD) – CHD is an anomaly of the heart (that develops during birth) involving one or more portions of the heart to develop abnormally. It can occur in the heart’s chambers, electrical system, blood vessels and valves. As per reports, CHD affects approximately 1 percent of newborns or about more than 40,000 births per year in the United States (2018 statistics). Symptoms include – rapid heartbeat, poor blood circulation and swelling in the legs, abdomen or areas around the eyes, a blue tinge to the skin and fast breathing. Newborn screening for critical congenital heart defects (critical CHDs) may help identify newborns with these conditions and allow for timely care and treatment.  The ICD-10 codes for congenital heart disease are –

  • Q20 – Congenital malformations of cardiac chambers and connections
  • Q21 – Congenital malformations of cardiac septa
  • Q22 – Congenital malformations of pulmonary and tricuspid valves
  • Q23 – Congenital malformations of aortic and mitral valves
  • Q24 – Other congenital malformations of heart
  • Q25 – Congenital malformations of great arteries
  • Q26 – Congenital malformations of great veins
  • Q27 – Other congenital malformations of peripheral vascular system
  • Q28 – Other congenital malformations of circulatory system

Coronary artery disease (CAD) – Coronary artery disease (CAD) occurs due to the narrowing and hardening of the coronary arteries, (the blood vessels that supply oxygen and blood to the heart). Regarded as one of the leading causes of death for both men and women in the US, CAD begins when hard cholesterol substances (plaques) get deposited within a coronary artery resulting in the formation of tiny clots that can obstruct the flow of blood to the heart muscles. Chest discomfort (angina) is one of the most common symptoms of coronary artery disease. Other additional symptoms include – pain in the arms or shoulders, shortness of breath, sweating, irregular heartbeat, dizziness and nausea. Treatment involves lifestyle changes, and possibly some medical procedures and medications.

Related ICD-10 codes include –

  • I25 – Chronic ischemic heart disease
  • I25.1 – Atherosclerotic heart disease of native coronary artery
  • I25.10 – Atherosclerotic heart disease of native coronary artery, without angina pectoris
  • I25.11 – Atherosclerotic heart disease of native coronary artery with angina pectoris
  • I25.110 – Atherosclerotic heart disease of native coronary artery with unstable angina pectoris
  • I25.111 – Atherosclerotic heart disease of native coronary artery with unstable angina pectoris, with documented spasm
  • I25.118 – Atherosclerotic heart disease of native coronary artery with other forms of angina pectoris
  • I25.119 – Atherosclerotic heart disease of native coronary artery with unspecified angina pectoris

Heart failure – Also known as congestive heart failure (CHF), this condition occurs when the heart muscles does not pump blood around the body efficiently, resulting in swelling, shortness of breath, and other issues. In most cases, the left or right side of the heart might be affected. CHF is often the result of a number of other conditions like – coronary artery disease, hypertension, cardiomyopathy, valve conditions, heart rhythm problems (arrhythmias), congenital heart disease and other conditions such as diabetes, thyroid disease, and obesity that damage the heart muscles.

Listen to our podcast on the diagnosis and management of Congestive Heart Failure!

The ICD-10 codes relevant to congestive heart failure (CHF) includes –

  • I50 – Heart failure
  • I50.1 – Left ventricular failure, unspecified
  • I50.2 – Systolic (congestive) heart failure
    • I50.20 – Unspecified systolic (congestive) heart failure
    • I50.21 – Acute systolic (congestive) heart failure
    • I50.22 – Chronic systolic (congestive) heart failure
    • I50.23 – Acute on chronic systolic (congestive) heart failure
  • I50.3 – Diastolic (congestive) heart failure
    • I50.30 – Unspecified diastolic (congestive) heart failure
    • I50.31 – Acute diastolic (congestive) heart failure
    • I50.32 – Chronic diastolic (congestive) heart failure
    • I50.33 – Acute on chronic diastolic (congestive) heart failure
  • I50.4 – Combined systolic (congestive) and diastolic (congestive) heart failure
    • I50.40 – Unspecified combined systolic (congestive) and diastolic (congestive) heart failure
    • I50.41 – Acute combined systolic (congestive) and diastolic (congestive) heart failure
    • I50.42 – Chronic combined systolic (congestive) and diastolic (congestive) heart failure
    • I50.43 – Acute on chronic combined systolic (congestive) and diastolic (congestive) heart failure
  • I50.8 – Other heart failure
    • I50.81 – Right heart failure
      • I50.810 – Right heart failure, unspecified
      • I50.811 – Acute right heart failure
      • I50.812 – Chronic right heart failure
      • I50.813 – Acute or chronic right heart failure
      • I50.814 – Acute or chronic right heart failure, due to left heart failure
      • I50.82 – Biventricular heart failure
      • I50.83 – High output heart failure
      • I50.84 – End stage heart failure
      • I50.89 – Other heart failure
  • I50.9 – Heart failure, unspecified

Myocardial infarction (MI) – Myocardial infarction (MI) or a heart attack occurs when a portion of the heart is deprived of oxygen as a result of the blockage of a coronary artery. The most common cause for this heart attack is occlusive intracoronary thrombus, a substance called plaque made up of cholesterol and other cells that build up in the walls of coronary arteries. A tear in the plaque triggers blood platelets and other substances to form a clot that blocks the flow of blood to the heart. For reimbursement purposes, report the following codes –

  • I21 – Acute myocardial infarction
  • I21.0 – ST elevation (STEMI) myocardial infarction of anterior wall
  • I21.1 – ST elevation (STEMI) myocardial infarction of inferior wall
  • I21.2 – ST elevation (STEMI) myocardial infarction of other sites
  • I21.3 – ST elevation (STEMI) myocardial infarction of unspecified site
  • I21.4 – Non-ST elevation (NSTEMI) myocardial infarction
  • I21.9 – Acute myocardial infarction, unspecified
  • I21.A – Other type of myocardial infarction
    • I21.A1 – Myocardial infarction type 2
    • I21.A9 – Other myocardial infarction type

Cardiomyopathy – Cardiomyopathy is a progressive disease of the myocardium or heart muscle that makes it harder for the heart to pump blood to the rest of the body. The exact cause of this condition isn’t known as it can be the result of other conditions (acquired) or passed on from a parent (inherited). In most cases, there may not be any signs or symptoms in the early stages of this heart condition. However, as the disease advances, several signs and symptoms may appear and these include – chest pain, swelling of the legs, ankles and feet, high blood pressure, heart palpitations, fatigue and dizziness and breathlessness with exertion or even at rest. There are different types of cardiomyopathy and these include – Arrhythmogenic right ventricular dysplasia, Hypertrophic, Dilated and Restrictive cardiomyopathy. Treatment modalities for this condition will vary and depend on the type of cardiomyopathy a person suffers and include – medications, radiofrequency ablation, septal ablation, and surgically implanted devices (such as implantable cardioverter-defibrillators (ICDs), ventricular assist devices (VADs) and pacemakers. Related ICD-10 codes include –

  • I42 – Cardiomyopathy
    • I42.0 – Dilated cardiomyopathy
    • I42.1 – Obstructive hypertrophic cardiomyopathy
    • I42.2 – Other hypertrophic cardiomyopathy
    • I42.3 – Endomyocardial (eosinophilic) disease
    • I42.4 – Endocardial fibroelastosis
    • I42.5 – Other restrictive cardiomyopathy
    • I42.6 – Alcoholic cardiomyopathy
    • I42.7 – Cardiomyopathy due to drug and external agent
    • I42.8 – Other cardiomyopathies
    • I42.9 – Cardiomyopathy, unspecified
  • I43 – Cardiomyopathy in diseases classified elsewhere

According to the World Health Organization (WHO), cardiovascular diseases (CVDs) are the leading cause of deaths globally. It is estimated that by the end of 2030, about 23.6 million people will die from cardiovascular diseases annually. The majority of CVDs are preventable. The risks of cardiac conditions can be reduced with preventive measures like maintaining a healthy weight, eating a healthy diet and exercising, keeping cholesterol and triglyceride levels under control, reducing salt intake, and not smoking.

Healthcare providers need to be knowledgeable about the highly specific ICD-10 codes to report common cardiovascular diseases. A reliable medical billing and coding company can provide the support physicians need to ensure accurate claim submission for optimal reimbursement.