She also worked for Alabama Quality Assurance Foundation (AQAF) as a coding reviewer/auditor before joining the team at Medical Management Plus, Inc. Susie has worked in the coding field for over 30 years and has worked as a coder, coding supervisor, and corporate coding manager for a large multi-facility system in Birmingham. Susie James, RHIT, CCS, is the Manager of Inpatient Coding Services at MMP, Inc. I hope this article has been beneficial in helping you become more familiar with cardiac diagnoses and conditions in ICD-10-CM. Please refer to the our article, ICD-10-CM Diseases of the Circulatory System, describing specific coding guidelines for cardiac diagnoses and conditions. Oblique marginal coronary artery (I21.21) Left anterior descending coronary artery (I21.02) For example, per the alpha index:Ĭoronary artery of anterior wall NEC (I21.09)Ĭoronary artery of inferior wall NEC (I21.19) NOTE FROM AUTHOR For Acute MIs, we can now identify the specific coronary artery impacted. If STEMI converts to NSTEMI due to thrombolytic therapy, it is still coded as STEMI. If NSTEMI evolves to STEMI, assign the STEMI code. Posterior (I21.29) (posterobasal) (posterolateral) (posteroseptal) (true) I21.29) Inferoposterior Transmural (Q wave) (I21.11) Inferior (I21.09) (diaphragmatic) (inferolateral) (inferoposterior) (wall) NEC (I21.19) Most MIs are considered to be ST-Elevation (STEMI) unless stated as Non-ST Elevation (NSTEMI) or Subendocardial.Īnterior (anteroapical) (anterolateral) (anteroseptal) (Q wave) (wall) (I21.09) The timeframe (stated duration of the MI) has decreased in I-10 to 4 weeks from 8 weeks in I-9.For the episode of care in I-10, MIs are identified as either Acute (I21.xx) or Subsequent (I22.xx).Infarct, Myocardial (acute) (with stated duration of 4 weeks or less) (I21.3) NOTE FROM MANUAL Note-Use the following fifth-digit subclassification with category 410:Ģ - subsequent episode without recurrence Infarct, Myocardial (acute or with a stated duration of 8 weeks or less) (with Hypertension) (410.9x) In addition, there are no specific codes for Postoperative Fibrillation or Postoperative Flutter in the alpha index.Ĭongestive Heart Failure (compensated) (decompensated) (428.0)Ĭongestive Heart Failure (compensated) (decompensated) (I50.9)Ĭombined with Systolic (congestive) (I50.40)Ĭombined with Diastolic (congestive) (I50.40) NOTE FROM AUTHOR Attention: There are specific descriptions for Atrial Fibrillation and Atrial Flutter in I-10. one code in I-10Ītrial Fibrillation (established) (paroxysmal) (427.31)Ītrial Fibrillation or Auricular (established) (I48.91) NOTE FROM AUTHOR Attention: Two codes in I-9 vs. Both paroxysmal and persistent AF may become more frequent and, over time, result in permanent AF.For the I-10 Corner this week, we are discussing a few of the specific coding differences for cardiac diagnoses and conditions in ICD-9-CM and ICD-10-CM.Īngina Pectoris with Atherosclerotic Heart Disease (ASHD):Īngina with ASHD, Unspecified-see Arteriosclerosis, Coronary (artery), Unspecified (I20.9) Permanent AF is a condition in which a normal heart rhythm can't be restored with treatment. It may stop on its own, or it can be stopped with treatment. Persistent AF is a condition in which the abnormal heart rhythm continues for more than a week. Persistent Atrial Fibrillation (I48.1 CC) They stop within about a week, but usually in less than 24 hours. In paroxysmal (par-ok-SIZ-mal) atrial fibrillation (AF), the faulty electrical signals and rapid heart rate begin suddenly and then stop on their own. The most recent clinical definitions of afib are: This coding quandary leaves the coder querying the physician each time atrial fibrillation is not specified. I48.9 Unspecified atrial fibrillation and atrial flutter.The ICD-10 Alphabetic Index shows the following tabular entries for atrial fibrillation: Developing clinical definitions will assist in the physician query process going forward but be sure physicians are involved and agree with your plan.Įxample- New codes for atrial fibrillation are without definition. Many facilities are developing clinical definitions regarding new terms and descriptive diagnostic modifiers. Do we query or not query? We must decide. How are coders and CDI specialists to know what do do? Well again, it all goes back to the physician.
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