Cardiovascular Disease Still a Major Health Risk

Cardiovascular diseases (CVD) are among the most serious and fatal disorders affecting Americans. CVD disorders affect the heart or blood vessels. Stroke, IHD (ischemic heart disease), RHD (rheumatic heart disease), congenital heart disease, hypertensive heart disease, PAD (peripheral artery disease), and endocarditis are some of the common cardiovascular disorders. Many of the cardiovascular diseases are the result of a process known as atherosclerosis or the build-up of plaque in the artery walls, which narrows them and constricts blood flow. If the constricted blood clots, it can totally prevent the flow of blood causing a stroke or heart attack.

Symptoms and CVD Varieties

• The narrowing of the blood vessel due to the build-up of plaque could result in shortness of breath and chest pain. This condition is called angina.
• A heart attack can occur when the blood vessel is completely blocked. Sometimes the plaque could rupture, which blocks the blood vessels and causes heart attack.
• The condition called arrhythmia where the heart beats either too fast or too slow could cause various symptoms including chest pain, shortness of breath, a fluttering experience in the chest, slow heartbeat, racing heartbeat, dizziness, lightheadedness or fainting.
• Cerebrovascular disease affects blood vessels that supply the brain. This could significantly hamper brain activity. Stroke is the result of clots in the blood vessels leading to the brain, or bleeding from one of the blood vessels within the brain.
• Problems with blood vessels connected to other parts of the body could also be the result of cardiovascular issues such as peripheral arterial disease that affects the arms or the legs.
• Rheumatic heart disease is the result of damage caused to the heart valves and heart muscles by rheumatic fever, a condition brought about by the streptococcal bacteria.
• Some individuals though are born with issues with heart structure causing congenital heart disease.

CVD in the World and the United States

In spite of the fact that 90% of cardiovascular disorders are preventable, they are the leading cause of fatality worldwide, causing 17.3 million deaths in 2013, a significant rise from the 12.3 million deaths reported in 1990. In the US it is estimated that 11% of individuals between 20 and 40 years of age have some form of CVD. Between the ages of 40 and 60 the percentage of individuals with cardiovascular disease is 37%. While the risk of death from heart disease has significantly reduced over the years in much of the developed world, the fact that there are instances of CVD in youngsters and that lifestyle conditions could induce risk of CVD long before it manifests in a potentially fatal condition make this still a significant risk.

While the developing world is said to be at a greater risk of death from heart disease, the CDC’s claims reveal that over a quarter of all the deaths in 2006 in the United States were the result of heart disease. Much progress in CVD awareness has been made in nearly a decade, though the risk remains. Around 610,000 people still die of heart disease each year in the United States with coronary heart disease being the most common, accounting for 370,000 of those 610,000 annual heart disease deaths. This is why periodic check-ups are essential and physicians should warn patients of potential risks.

Getting the Medical Codes Right

ICD-9-CM

Here are the ICD-9-CM codes for the various cardiovascular disorders:

• Ischemic heart diseases – 410-414
• Hypertensive diseases – 401-405
• Chronic rheumatic heart diseases – 393-398
• Acute rheumatic fever – 390-392
• Pulmonary circulation diseases – 415-417
• Other kinds of heart disease – 420-429
• Diseases affecting arteries, arterioles and capillaries – 440-449
• Diseases affecting veins and lymphatics, and other circulatory system diseases – 451-459 
• Cerebrovascular diseases – 430-438

It is important to remember that the sub-codes depicting the detailed condition must be incorporated.

For example, ischemic heart diseases are covered by codes from 401 to 405. Acute myocardial infarction comes under this classification and is broadly depicted by 410. There are further sub-codes under this depicting specific conditions:

• Acute myocardial infarction of anterolateral wall, unspecified episode of care – 410.00
• Acute myocardial infarction of anterolateral wall, initial episode of care – 410.01
• Acute myocardial infarction of anterolateral wall, subsequent episode of care – 410.02

ICD-10-CM

Coding for cardiovascular diseases must be done carefully since there are various sub-conditions within the common disorders that have specific codes. According to the ICD-10 CM guidelines, the sequencing and code selection rules must be understood well to prevent rejection of claims, delays in submission or loss in revenue.

Cardiovascular disorders come under the classification of disorders of the circulatory system. Here are the ICD-10-CM diagnosis codes the various CVD conditions:

• Ischemic heart diseases – I20-I25
• Hypertensive diseases – I10-I15
• Chronic rheumatic heart diseases – I05-I09
• Acute rheumatic fever – I00-I02
• Pulmonary heart disease and other pulmonary circulation diseases – I26-I28
• Other kinds of heart disease – I30-I52
• Diseases affecting arteries, arterioles as well as capillaries – I70-I79
• Diseases affecting veins, lymphatic vessels as well as lymph nodes – I80-I89
• Cerebrovascular diseases – I60-I69
• Other diseases affecting the circulatory system – I95-I99

For each of these codes there are sub-codes that accurately represent specific conditions. These must be the ones used for billing. For example, the codes for chronic rheumatic diseases are from I05 to I09. But when it comes to the sub-condition, rheumatic mitral valve diseases, the sub-codes are the following:

• Rheumatic mitral stenosis – I05.0
• Rheumatic mitral insufficiency – I05.1
• Rheumatic mitral stenosis with insufficiency – I05.2
• Other rheumatic mitral valve diseases – I05.8
• Rheumatic mitral valve disease, unspecified – I05.9

These codes depicting specific conditions are those accepted for billing. But ICD-10-CM codes would replace ICD-9-CM only from October 1, 2015. Till then, only ICD-9-CM codes are accepted for billing.

Treatment Options and CPT Codes

Treatment options vary based on the severity of the condition and areas affected. In conditions where plaque build-up has occurred, coronary angioplasty is the most common treatment. The procedure involves threading a balloon into the blocked blood vessel and then inflating it, which pushes the plaque to the sides of the blood vessel, clearing the passage. In some cases, the procedure also involves placing a stent to keep the blood vessel free and open. The other treatment options include placing a pacemaker and conducting bypass surgery of the heart. There are also cardiac drugs including anticoagulants and antiplatelet agents.

To receive reimbursement for the treatment provided, physicians must use the right CPT codes on their medical claims.

For example, here are the CPT codes for some of the coronary artery bypass procedures:

• Coronary artery bypass using venous graft – 33510 to 33516
• Coronary artery bypass with venous graft plus arterial graft – 33517 to 33536 (these codes must be listed along with the primary procedure code)

2015 has seen revisions to some CPT codes for cardiovascular treatment. Here are some of the revised codes for:

• Pacemaker/implantable defibrillator – 33215 to 33273
• Stenting – 37215 to 37218, 37236 and 37237 (the latter code to be listed along with primary procedure code)

Though these are broad classifications, each specific treatment within these classifications has a code while sub-treatments have sub-codes that must be added along with the primary code.

Research Shows Importance of the Right Tests

Recent research has revealed interesting information about CVD tests.  A CT scan has been found to be more effective in ruling out the requirement for further tests and procedures for patients free from heart disease. The study was conducted on 10,003 patients who had visited 193 health centers. They did not have any prior diagnosis of coronary artery disease, but developed new symptoms causing suspicions of the disease, particularly since almost all of them had at least a single risk factor for CVD including diabetes, smoking or high blood pressure.

However, there were no differences between the effects of heart CT scan and functional heart tests with regard to hospitalization, heart attack or procedural complications. The results have great significance since, according to current clinical guidelines, the choice of tests for symptoms such as shortness of breath or chest pain is left to the patients and physicians.

Heart Doctors Need More Lifestyle and Diet Training

Though diet and lifestyle factors are often paraded as causes for the CVD, this study by the NYU Langone Medical Center has revealed that a majority of the surveyed doctors would welcome any amount of further training with regard to diet and nutrition so they would be able to help patients better. More than half the respondents also revealed that they spent 3 minutes or even less in educating their patients about lifestyle and diet requirements.  78% of the respondents felt further training would ensure better patient care.

It’s clear that cardiovascular disease is still a major risk. However, some more preparation from doctors and a greater awareness of preventive lifestyle and diet factors can help bring the death toll much lower.