Correct selection of ICD-10-CM codes for peripheral vascular disease requires careful review of the index entries and instructional notes that guide the coding process. This Coding Tip aims to highlight key points in relation to determining correct codes and complete coding.
There are several things to know about assigning diagnosis codes for peripheral vascular disease that ensure correct coding as outlined below.
When the diagnosis documented in the health record states only, “Peripheral vascular disease/PVD or peripheral artery disease/PAD, the ICD-10-CM Alphabetic Index directs the assignment of code I73.9 Peripheral vascular disease, unspecified.
Verification in the Tabular List shows that intermittent claudication and peripheral angiopathy, not otherwise specified, are also included in this code. The Excludes1 note under this code indicates that I73.9 is not appropriate for reporting peripheral vascular or arterial disease due to atherosclerosis. When PVD or PAD is documented as secondary to atherosclerotic disease the codes to report come from subcategories I70.2- thru I70.7-.
This is supported by advice in AHA Coding Clinic which clarifies that when interpreting an Excludes1 note, of the two codes being compared, only the code referenced in the Excludes note is assigned.
When peripheral vascular or arterial disease is secondary to atherosclerotic disease, the Alphabetic Index directs the coder to “see Arteriosclerosis”.
Under the main term Arteriosclerosis, many subterms related to the arteries of the extremities, including the legs, send the coder to the subcategories of I70.2- thru I70.7. Index entries are differentiated by variables such as whether the diseased vessel is a native artery or bypass graft, manifestations of the disease (e.g., with rest pain and/or gangrene), site of ulcerations (e.g., calf, heel) and site of disease, including laterality, when the site is a leg(s).
As always, preliminary codes directed for use by the index should be verified in the Tabular List to determine correctness of code selection and if there are any instructional notes that must be applied before final code assignment.
The Tabular List has a few important instructional notes that must the applied to ensure coding for peripheral vascular/arterial disease is correct and complete.
A patient presents for atherectomy due to atherosclerotic peripheral vascular disease with rest pain and ulcer of the left midfoot.
ICD-10-CM Code: I70.244 Atherosclerosis of native arteries of left leg with ulceration of heel and midfoot. Based on the instructional note under subcategory I70.24, code I70.222 Atherosclerosis of native arteries of extremities with rest pain, left leg is not also assigned because PVD/PAD with a manifestation of rest pain is included in the code for PVD/PAD with ulceration.
An appropriate ulcer code from category L97 would also be assigned.
In ICD-10-CM, diabetes and peripheral angiopathy are linked by the term “with” in the Alphabetic Index.
This means that for diabetic patients with peripheral angiopathy, combination code E11.51 Type 2 diabetes mellitus with diabetic peripheral angiopathy without gangrene, should be assigned. Coding Clinic confirms that peripheral arteriosclerosis, peripheral vascular disease and peripheral arterial disease are forms of angiopathy and should therefore, in a diabetic patient, be linked and coded as diabetic peripheral angiopathy.
For more in-depth instruction in diagnosis code assignment for peripheral vascular disease see HIAlearn’s eBook Peripheral Vascular Disease Coding in ICD-10-CM.
For instruction in outpatient coding of procedures used to treat peripheral vascular disease please visit HIAlearn’s course Endovascular Revascularization of Lower Extremities Coding in CPT.For more than 30 years, HIA has been the leading provider of compliance audits, coding support services and clinical documentation audit services for hospitals, ambulatory surgery centers, physician groups and other healthcare entities. HIA offers PRN support as well as total outsource support.
The information contained in this coding advice 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.