diseases of the circulatory system i00-i99 - cypress...

Chapter 9 Circulatory System October 20, 2011

Cypress College HIT Program ICD 10-Webinar Series 1

Chapter 9 Diseases of the Circulatory System

I00-I99

I00–I02 Acute rheumatic feverI05–I09 Chronic rheumatic heart diseaseI10–I15 Hypertensive diseasesI20–I25 Ischemic heart diseasesI26–I28 Pulmonary heart disease & diseases of pulmonary circulationI30–I52 Other forms of heart diseaseI60–I69 Cerebrovascular diseasesI70–I79 Diseases of arteries, arterioles and capillaries I80–I89 Diseases of veins, lymphatic vessels and lymph nodes, NEC I95–I99 Other and unspecified disorders of the circulatory system

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Use additional code to identify:• Exposure to environmental tobacco smoke (Z58.83)• History of tobacco use (Z87.82)• Occupational exposure to environmental tobacco smoke

(Z57.31) • Tobacco dependence (F17.–)• Tobacco use (Z72.0)• Body Mass Index

Excludes◦HTN complicating pregnancy

I10 Essential (primary HTN)◦Use for both benign and malignantI11 Hypertensive heart disease ◦ A condition listed in the “Includes” note is due to HTN◦ Must be a causal relationship◦ Code also the type of heart failure

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Combination of HTN and condition classifiable to N18 Chronic Kidney DiseaseCause and effect relationship is assumed with HTN and CKDDifferent HTN codes based upon stage of CKDUse additional code for stage of CKD –(N18.-)Use additional code for Heart failure – (I50.-)

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28-day period (4 weeks)I21 ST elevation (STEMI) and non-ST elevation (NSTEMI) MI◦ 4th digits describe site of infarction

All STEMI except I21.45th digit identifies coronary artery

Left main, LAD, RCA, inferior, left circumflex, other

I22 Subsequent acute MI ◦ 2nd MI (new) within initial 4 week periodNot subsequent episode of care

I23 Certain complications of MI5

I25.1 Atherosclerotic heart disease of native coronary artery, ◦ 5th characters refer to without angina, with

unspecified angina pectoris, with unstable angina, with documented spasm, or with other forms of angina pectoris.

I25.2 Old MI (after 4 weeks)I25.7 CAD of bypass graft(s) of coronary artery in a transplanted heart◦ Add 6th characters for type of angina

pectoris

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I26 Pulmonary embolism• Directs the coder to code first a

pulmonary embolism complicating abortion, ectopic, or molar pregnancy (O00-O07, O08.2) or pregnancy, childbirth, and the puerperium (O88.–).

• Then presence or absence of acute corpulmonale

I46 Cardiac arrest• I46.2 Cardiac arrest due to underlying

cardiac condition• I46.8 Cardiac arrest due to other

underlying condition• I46.9 Cardiac arrest, cause unspecified

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Code first◦ HF complicating abortion, ectopic, molar pregnancy◦ HF following surgery (I97.13)◦ HF due to HTN (I11.0)◦ HF due to HTN with CKD (I13.-)◦ Obstetric surgery & procedures (O75.4)◦ Rheumatic heart failure (I09.81)Systolic/Diastolic/Combined◦ Congestive – nonessential modifier ◦ Acute, chronic, acute and chronic, unspecifiedI50.9 Heart failure, unspecified◦ Includes CHF, NOS

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I60 Nontraumatic subarachnoid hemorrhages• 4th characters identify specific artery

• I63 Cerebral infarction• Thrombosis/embolism• Precerebral, basilar, carotid, cerebral, anterior cerebral,

• I65 Occlusion of precerebral arteries not resulting in infarction

• I66 Occlusion of cerebral arteries not resulting in infarction

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Late effects – neurologic deficits –◦ Categories I60-I674th digits specify cause, 5th digit sequelaI69.0 Sequelae of nontraumatic subarachnoid hemorrhage◦ I69.00 Unspecified late effects of nontraumatic

subarachnoid hemorrhageI69.01 Cognitive deficits following nontraumaticsubarachnoid hemorrhage

I69.3 Sequelae of cerebral infarctionI69.8 Sequelae of other cerebrovascular diseaseI69.9 Sequelae of unspecified CV disease

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I95 Hypotension◦ Due to drugs or hemodialysisI96 Gangrene ◦ Moved from chapter 16 SymptomsI97 Intraoperative and postproceduralcomplications and disorders of the circulatory system, NEC◦ 4th, 5th, & 6th characters for

HemorrhageHematomaAccidental puncture and lacerationPostcardiotomy syndromePostmastectomy lymphedema syndrome

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Codes differentiate on ◦ Native vessels◦ Nonautologous biological bypass graft◦ Autologous vein bypass graft ◦ Other Type of bypass graft ◦ Unspecified type of bypass graft Use additional code, if applicable, to identify chronic total occlusion of artery◦ Extremity– I70.92◦ Coronary artery– I25.82

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1. Malignant Hypertension

2. Hypertensive congestive heart failure; acute on chronic systolic heart failure. BMI was 25

3. Rheumatic heart disease; chronic diastolic heart failure.

4. Acute thrombotic occlusion of the left carotid artery with infarction. On discharge she was still experiencing dysphagia; patient has residual right-sided hemiplegia (non-dominant) from previous CVA patient had two years ago

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5. Patient with unstable angina and severe coronary arteriosclerotic disease was admitted for coronary artery bypass. Patient had suffered an Acute anterior wall STE-myocardial infarction six weeks prior to admission.

Procedure: Triple vessel CABG; 2 saphenous veins to left circumflex and right obtuse marginal and one LIMA to LAD; patient placed on cardiopulmonary bypass; venous grafts were harvested from the left greater saphenous vein.

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6. During bowling tournament, patient began experiencing severe chest pain. On admission to the ED, the doctor documented unstable angina. While waiting for transfer to ICU, the pain got worse evolving into myocardial infarction in the ED. Infusion of tPA was started immediately. The patient was taken to the Cardiac Cath Lab for Left Heart Catheterization and left ventriculographyand coronary angiography. There was 90% occlusion in the LAD and circumflex. The cardiologist performed a PTCA of the circumflex and LAD with insertion of a drug-eluting stent into the circumflex.

Final Diagnosis: STE myocardial Infarction, anterior wall and circumflex artery; Unstable Angina; 90% occlusion of the circumflex Artery; 75 % occlusion of the obtuse marginal; 25.0 Body Mass Index

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7. Chapter 7: Diseases of Eye and Adnexa (H00-H59) Reserved for future guideline expansion

8. Chapter 8: Diseases of Ear and Mastoid Process (H60-H95) Reserved for future guideline expansion

9. Chapter 9: Diseases of Circulatory System (I00-I99)

a. Hypertension

1) Hypertension with Heart Disease Heart conditions classified to I50.- or I51.4-I51.9, are assigned to, a code from category I11, Hypertensive heart disease, when a causal relationship is stated (due to hypertension) or implied (hypertensive). Use an additional code from category I50, Heart failure, to identify the type of heart failure in those patients with heart failure. The same heart conditions (I50.-, I51.4-I51.9) with hypertension, but without a stated causal relationship, are coded separately. Sequence according to the circumstances of the admission/encounter.

2) Hypertensive Chronic Kidney Disease Assign codes from category I12, Hypertensive chronic kidney disease, when both hypertension and a condition classifiable to category N18, Chronic kidney disease (CKD), are present. Unlike hypertension with heart disease, ICD-10-CM presumes a cause-and-effect relationship and classifies chronic kidney disease with hypertension as hypertensive chronic kidney disease. The appropriate code from category N18 should be used as a secondary code with a code from category I12 to identify the stage of chronic kidney disease. See Section I.C.14. Chronic kidney disease.

If a patient has hypertensive chronic kidney disease and acute renal failure, an additional code for the acute renal failure is required.

3) Hypertensive Heart and Chronic Kidney Disease Assign codes from combination category I13, Hypertensive heart and chronic kidney disease, when both hypertensive

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kidney disease and hypertensive heart disease are stated in the diagnosis. Assume a relationship between the hypertension and the chronic kidney disease, whether or not the condition is so designated. If heart failure is present, assign an additional code from category I50 to identify the type of heart failure. The appropriate code from category N18, Chronic kidney disease, should be used as a secondary code with a code from category I13 to identify the stage of chronic kidney disease. See Section I.C.14. Chronic kidney disease. The codes in category I13, Hypertensive heart and chronic kidney disease, are combination codes that include hypertension, heart disease and chronic kidney disease. The Includes note at I13 specifies that the conditions included at I11 and I12 are included together in I13. If a patient has hypertension, heart disease and chronic kidney disease then a code from I13 should be used, not individual codes for hypertension, heart disease and chronic kidney disease, or codes from I11 or I12.

For patients with both acute renal failure and chronic kidney disease an additional code for acute renal failure is required.

4) Hypertensive Cerebrovascular Disease For hypertensive cerebrovascular disease, first assign the appropriate code from categories I60-I69, followed by the appropriate hypertension code.

5) Hypertensive Retinopathy Subcategory H35.0, Background retinopathy and retinal vascular changes, should be used with code I10, Essential (primary) hypertension, to include the systemic hypertension. The sequencing is based on the reason for the encounter.

6) Hypertension, Secondary Secondary hypertension is due to an underlying condition. Two codes are required: one to identify the underlying etiology and one from category I15 to identify the hypertension. Sequencing of codes is determined by the reason for admission/encounter.

7) Hypertension, Transient Assign code R03.0, Elevated blood pressure reading without diagnosis of hypertension, unless patient has an established

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diagnosis of hypertension. Assign code O13.-, Gestational [pregnancy-induced] hypertension without significant proteinuria, or O14.-, Pre-eclampsia, for transient hypertension of pregnancy.

8) Hypertension, Controlled This diagnostic statement usually refers to an existing state of hypertension under control by therapy. Assign the appropriate code from categories I10-I15, Hypertensive diseases.

9) Hypertension, Uncontrolled Uncontrolled hypertension may refer to untreated hypertension or hypertension not responding to current therapeutic regimen. In either case, assign the appropriate code from categories I10-I15, Hypertensive diseases.

b. Atherosclerotic Coronary Artery Disease and Angina ICD-10-CM has combination codes for atherosclerotic heart disease with angina pectoris. The subcategories for these codes are I25.11, Atherosclerotic heart disease of native coronary artery with angina pectoris and I25.7, Atherosclerosis of coronary artery bypass graft(s) and coronary artery of transplanted heart with angina pectoris. When using one of these combination codes it is not necessary to use an additional code for angina pectoris. A causal relationship can be assumed in a patient with both atherosclerosis and angina pectoris, unless the documentation indicates the angina is due to something other than the atherosclerosis. If a patient with coronary artery disease is admitted due to an acute myocardial infarction (AMI), the AMI should be sequenced before the coronary artery disease.

See Section I.C.9. Acute myocardial infarction (AMI)

c. Intraoperative and Postprocedural Cerebrovascular Accident Medical record documentation should clearly specify the cause- and-effect relationship between the medical intervention and the cerebrovascular accident in order to assign a code for intraoperative or postprocedural cerebrovascular accident. Proper code assignment depends on whether it was an infarction or hemorrhage and whether it occurred intraoperatively or postoperatively. If it was a cerebral hemorrhage, code assignment depends on the type of procedure performed.

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d. Sequelae of Cerebrovascular Disease

1) Category I69, Sequelae of Cerebrovascular disease Category I69 is used to indicate conditions classifiable to categories I60-I67 as the causes of late effects (neurologic deficits), themselves classified elsewhere. These “late effects” include neurologic deficits that persist after initial onset of conditions classifiable to categories I60-I67. The neurologic deficits caused by cerebrovascular disease may be present from the onset or may arise at any time after the onset of the condition classifiable to categories I60-I67.

2) Codes from category I69 with codes from I60-I67 Codes from category I69 may be assigned on a health care record with codes from I60-I67, if the patient has a current cerebrovascular disease and deficits from an old cerebrovascular disease.

3) Code Z86.73 Assign code Z86.73, Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits (and not a code from category I69) as an additional code for history of cerebrovascular disease when no neurologic deficits are present.

e. Acute myocardial infarction (AMI)

1) ST elevation myocardial infarction (STEMI) and non ST elevation myocardial infarction (NSTEMI) The ICD-10-CM codes for acute myocardial infarction (AMI) identify the site, such as anterolateral wall or true posterior wall. Subcategories I21.0-I21.2 and code I21.4 are used for ST elevation myocardial infarction (STEMI). Code I21.4, Non-ST elevation (NSTEMI) myocardial infarction, is used for non ST elevation myocardial infarction (NSTEMI) and nontransmural MIs.

If NSTEMI evolves to STEMI, assign the STEMI code. If STEMI converts to NSTEMI due to thrombolytic therapy, it is still coded as STEMI.

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When the patient requires continued care for the myocardial infarction, codes from category I21 may continue to be reported for the duration of 4 weeks (28 days) or less from onset, regardless of the healthcare setting, including when a patient is transferred from the acute care setting to the post-acute care setting if the patient is still within the four weeks time frame. For encounters after the 4 weeks time frame and the patient requires continued care related to the myocardial infarction, the appropriate aftercare code should be assigned, rather than a code from category I21. Otherwise, code I25.2, Old myocardial infarction, may be assigned for old or healed myocardial infarction not requiring further care.

2) Acute myocardial infarction, unspecified Code I21.3, ST elevation (STEMI) myocardial infarction of unspecified site, is the default for the unspecified term acute myocardial infarction. If only STEMI or transmural MI without the site is documented, query the provider as to the site, or assign code I21.3.

3) AMI documented as nontransmural or subendocardial but site provided If an AMI is documented as nontransmural or subendocardial, but the site is provided, it is still coded as a subendocardial AMI. See Section I.C.21.3 for information on coding status post administration of tPA in a different facility within the last 24 hours.

4) Subsequent acute myocardial infarction A code from category I22, Subsequent ST elevation (STEMI) and non ST elevation (NSTEMI) myocardial infarction, is to be used when a patient who has suffered an AMI has a new AMI within the 4 week time frame of the initial AMI. A code from category I22 must be used in conjunction with a code from category I21. The sequencing of the I22 and I21 codes depends on the circumstances of the encounter. Should a patient who is in the hospital due to an AMI have a subsequent AMI while still in the hospital code I21 would be sequenced first as the reason for admission, with code I22 sequenced as a secondary code. Should a patient have a subsequent AMI after discharge for

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care of an initial AMI, and the reason for admission is the subsequent AMI, the I22 code should be sequenced first followed by the I21. An I21 code must accompany an I22 code to identify the site of the initial AMI, and to indicate that the patient is still within the 4 week time frame of healing from the initial AMI. The guidelines for assigning the correct I22 code are the same as for the initial AMI.

10. Chapter 10: Diseases of Respiratory System (J00-J99)

a. Chronic Obstructive Pulmonary Disease [COPD] and Asthma

1) Acute exacerbation of chronic obstructive bronchitis and asthma

The codes in categories J44 and J45 distinguish between uncomplicated cases and those in acute exacerbation. An acute exacerbation is a worsening or a decompensation of a chronic condition. An acute exacerbation is not equivalent to an infection superimposed on a chronic condition, though an exacerbation may be triggered by an infection.

b. Acute Respiratory Failure

1) Acute respiratory failure as principal diagnosis A code from subcategory J96.0, Acute respiratory failure, or subcategory J96.2, Acute and chronic respiratory failure, may be assigned as a principal diagnosis when it is the condition established after study to be chiefly responsible for occasioning the admission to the hospital, and the selection is supported by the Alphabetic Index and Tabular List. However, chapter-specific coding guidelines (such as obstetrics, poisoning, HIV, newborn) that provide sequencing direction take precedence.

2) Acute respiratory failure as secondary diagnosis Respiratory failure may be listed as a secondary diagnosis if it occurs after admission, or if it is present on admission, but does not meet the definition of principal diagnosis.

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2011 ICD 10-CM & ICD-10-PCS Training Webinar Series!

Cypress College Health Information Technology Program

Certificate of Attendance Name AHIMA # /Credential

Instructions: Complete identification information above. Record number of hours for each session. Enter Total. Retain this form as verification in the event you are selected for an audit.

Date Topic Number of Hours Attended

February 10, 2011 1:30 pm- 2:30 pm

Chapter 4. Endocrine, nutritional and metabolic disorders

March 10, 2011 1:30 pm- 2:30 pm

Chapter 5. Mental and behavioral disorders

April 14, 2011 1:30 pm- 2:30 pm

Chapter 6. Diseases of the Nervous System

May 12, 2011 1:30 pm- 2:30 pm

Chapter 7. Diseases of the Eye and Adnexa Chapter 8. Diseases of the Ear and Mastoid Process

Summer Break October 20, 2011 1:30 pm- 2:30 pm

Chapter 9. Disease of the Circulatory System

November 10, 2011 1:30 pm- 2:30 pm

Chapter 10. Diseases of the Respiratory System

December 8, 2011 1:30 pm- 2:30 pm

Chapter 11 Diseases of the Digestive System

Total Number of Hours Attended

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Link to Archived Sessions of Cypress College ICD 10-CM/ICD 10-PCS Webinars

To view the Archived Webinars of the 2010 ICD 10-CM sessions, click on http://sas.elluminate.com/site/external/recording/playback/link/table/meeting?suid=M.7D8A3C61A3401FDFBDDF03CAD0C86B Links to the handouts that match each archive are below.

April 8: Introduction to ICD 10-CM and ICD 10-PCS Official Coding Guidelines and ICD-10-PCS Root Operations

May 13: Chapter 20: External Causes of Morbidity June 10: Chapter 21: Factors Influencing health status and contact with health services

o Chapter 18: Symptoms, signs, and abnormal clinical and laboratory findings. August 12: Chapter 19: Injury, poisoning and certain other consequences of external causes. October 14: Chapter 1 Infections Diseases November 1: Chapter 2 Neoplasms December 9: Chapter 3 Diseases of Blood and Blood Forming Organs

To view the Archived Webinars of the 2011 ICD 10-CM sessions, click on https://sas.elluminate.com/site/external/recording/playback/link/table/meeting?suid=M.A93EA47CFBDCE15D5277B73ABEFE3F Links to the handouts that match each archive are below.

February 10, 2011: Chapter 4 Endocrine -- do not think there is sound on this archive March 10, 2011: Chapter 5 Mental and Behavioral Disorders April 14, 2011: Chapter 6 Diseases of the Nervous System May 12, 2011: Chapter 7 Diseases of the Eye & Adnexa

o Chapter 8 Diseases of the Ear and Mastoid Process October 10, 2011: Chapter 9 Circulatory System

Links to session Handouts in ICD 10-CM are listed below in ICD 10-CM chapter number order.

Introduction to ICD 10‐CM and ICD 10‐PCS

http://webdav.cypresscollege.edu/~hit/ICD10Handouts/2010_04_08_BasicIntroductionICD10.pdf

Root Operations for ICD 10-PCS

http://webdav.cypresscollege.edu/~hit/ICD10Handouts/RootOperations.pdf

Chapter 1 Infectious Diseases

http://webdav.cypresscollege.edu/~hit/ICD10Handouts/2010_10_14_Chapter01InfectiousDisease.

Chapter 2 Neoplasms

http://webdav.cypresscollege.edu/~hit/ICD10Handouts/2010_11_11_Chapter02NeoplasmHandout.pdf

Chapter 3 Blood and Blood forming

http://webdav.cypresscollege.edu/~hit/ICD10Handouts/2010_12_09_Chapter03Blood.pdf

Chapter 4 Endocrine

http://webdav.cypresscollege.edu/~hit/ICD10Handouts/2011_02_10_Chapter04Endocrine2.pdf

Chapter 5 Mental Health Disorders

http://webdav.cypresscollege.edu/~hit/ICD10Handouts/2011_03_10_Chapter05Mental.pdf

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http://sas.elluminate.com/site/external/recording/playback/link/table/meeting?suid=M.7D8A3C61A3401FDFBDDF03CAD0C86B

http://sas.elluminate.com/site/external/recording/playback/link/table/meeting?suid=M.7D8A3C61A3401FDFBDDF03CAD0C86B

https://sas.elluminate.com/site/external/recording/playback/link/table/meeting?suid=M.A93EA47CFBDCE15D5277B73ABEFE3F

https://sas.elluminate.com/site/external/recording/playback/link/table/meeting?suid=M.A93EA47CFBDCE15D5277B73ABEFE3F

http://webdav.cypresscollege.edu/~hit/ICD10Handouts/2010_04_08_BasicIntroductionICD10.pdf

http://webdav.cypresscollege.edu/~hit/ICD10Handouts/RootOperations.pdf

http://webdav.cypresscollege.edu/~hit/ICD10Handouts/2010_10_14_Chapter01InfectiousDisease

http://webdav.cypresscollege.edu/~hit/ICD10Handouts/2010_11_11_Chapter02NeoplasmHandout.pdf

http://webdav.cypresscollege.edu/~hit/ICD10Handouts/2010_12_09_Chapter03Blood.pdf

http://webdav.cypresscollege.edu/~hit/ICD10Handouts/2011_02_10_Chapter04Endocrine2.pdf

http://webdav.cypresscollege.edu/~hit/ICD10Handouts/2011_03_10_Chapter05Mental.pdf

Link to Archived Sessions of Cypress College ICD 10-CM/ICD 10-PCS Webinars

Chapter 6 Nervous System

http://webdav.cypresscollege.edu/~hit/ICD10Handouts/2011_04_14_Chapter06NervousSystem.pdf

Chapter 7 Disease and Disorders of the Eye and Chapter 8 Ear

http://webdav.cypresscollege.edu/~hit/ICD10Handouts/2011_05_12_Chapter07Eye_8Ear.pdf

Chapter 9 Circulatory System

http://webdav.cypresscollege.edu/~hit/ICD10Handouts/2011_10_20Chapter9CirculatorySystem.pdf

Chapter 18 Signs and Symptoms

http://webdav.cypresscollege.edu/~hit/ICD10Handouts/2010_06_10_Chapter18SignsSymptoms.pdf

Chapter 19 Injuries

http://webdav.cypresscollege.edu/~hit/ICD10Handouts/2010_08_12_Chapter19Injuries.pdf

Chapter 20 External Causes of Morbidity

http://webdav.cypresscollege.edu/~hit/ICD10Handouts/2010_05_13_Chapter20ExternalCauses.pdf

Chapter 21 Factors Influencing Health Status

http://webdav.cypresscollege.edu/~hit/ICD10Handouts/2010_06_10_Chapter21FactorsHealthStatus.pdf

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http://webdav.cypresscollege.edu/~hit/ICD10Handouts/2011_04_14_Chapter06NervousSystem.pdf

http://webdav.cypresscollege.edu/~hit/ICD10Handouts/2011_05_12_Chapter07Eye_8Ear.pdf

http://webdav.cypresscollege.edu/~hit/ICD10Handouts/2011_10_20Chapter9CirculatorySystem.pdf

http://webdav.cypresscollege.edu/~hit/ICD10Handouts/2010_06_10_Chapter18SignsSymptoms.pdf

http://webdav.cypresscollege.edu/~hit/ICD10Handouts/2010_08_12_Chapter19Injuries.pdf

http://webdav.cypresscollege.edu/~hit/ICD10Handouts/2010_05_13_Chapter20ExternalCauses.pdf

http://webdav.cypresscollege.edu/~hit/ICD10Handouts/2010_06_10_Chapter21FactorsHealthStatus.pdf

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