In 2019, we reviewed over 50,000 diagnosis codes from many different specialties for our Professional Fee clients. Below are the top three ICD-10-CM chapters where HIA identified coding opportunities.
- Z00-Z99 – Factors influencing health status and contact with health services
- I00-I99 – Circulatory system
- R00-R99 – Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified
For part 2 of this 3-part series, we will look at I00-I99 – circulatory system.
I00-I99 – Circulatory system
The Circulatory chapter is one that is identified every year as having a large number of coding changes. Many of these changes are related to documentation providing more specificity and, in some cases, less specificity than the codes reported. Below we will discuss some of the areas of opportunity in this chapter:
- I10 – Hypertension. Hypertension continues to be an identified coding opportunity every year. Many of these changes were due to not following the official coding guidelines when the documentation also supports the patient having heart disease and/or kidney disease. Remember ICD-10-CM assumes a relationship when hypertension is documented “with” heart disease and/or kidney disease.
References:
Coding Clinic, Third Quarter ICD-10 2019 Page 3
Coding Clinic, Fourth Quarter 2019 Pages 88 – 89
ICD-10 Official Guidelines: Section I. Conventions, general coding guidelines and chapter specific guidelines, C. Chapter-Specific Coding Guidelines. 9. Chapter 9: Disease of Circulatory System (I00-I99) a. Hypertension
- I25.1 through I25.119 – Atherosclerotic heart disease of native coronary artery (CAD).
- Coding opportunities related to reporting the correct CAD code when documentation also supported the patient having angina and the specific type of angina. ICD-10-CM has specific codes for patients who have CAD with angina and even more specific codes when the type of angina is documented.
- On the flip side coding opportunities were identified where the CAD code with angina was assigned when angina was not documented in the encounter. CAD with angina should only be assigned when documentation states the patient has angina.
References:
ICD-10 Official Guidelines: Section I. Conventions, general coding guidelines and chapter specific guidelines, C. Chapter-Specific Coding Guidelines. 9. Chapter 9: Disease of Circulatory System (I00-I99) b. Atherosclerotic Coronary Artery Disease and Angina
- I63.9 – Cerebral infarction, unspecified. Cases were identified where the unspecified cerebral infarction code was assigned when the specific type of cerebral infarction was documented in the encounter. Providers/Coders should be encouraged to report the diagnosis codes to the furthest specificity when documentation exists.
References:
ICD-10 Official Guidelines: Section I. Conventions, general coding guidelines and chapter specific guidelines, C. Chapter-Specific Coding Guidelines. 9. Chapter 9: Disease of Circulatory System (I00-I99) c. Intraoperative and Postprocedural Cerebrovascular Accident
Coding Clinic, Fourth Quarter 2018: Page 16
The information contained in this post is valid at the time of posting. Viewers are encouraged to research subsequent official guidance in the areas associated with the topic as they can change rapidly.