2018 ICD-10 Code Changes for Diseases of the Circulatory System

Chapter 9 deals with the diseases of the circulatory system. With the 2018 ICD-10 code changes, 19 codes were added to this chapter.  In our continuing series on the 2018 ICD-10 code changes, this blog will explore these updates and more regarding Chapter 9.

Pulmonary Hypertension

Pulmonary Hypertension is classified to category 127, which is known as other pulmonary heart diseases.  There are also secondary Pulmonary Hypertension codes associated with certain conditions or adverse effects related to drugs or toxins. Within this category, there are seven new Pulmonary Hypertension codes, which are sequenced based on the type of encounter:

  • 0  Primary Pulmonary Hypertension is expanded.
  • 20 Pulmonary Hypertension unspecified or NOS.
  • 21 Secondary Pulmonary Arterial Hypertension, is group 1 and is drug induced.
  • 22 Pulmonary Hypertension due to left heart disease is group 2.
  • 23 Pulmonary Hypertension due to lung disease and hypoxia is group 3.
  • 24 Chronic Thromboembolic Pulmonary Hypertension is group 4.
  • 29 Other secondary Pulmonary Hypertension is group 5.

As illustrated above, there are groups 1-5, but according to the codes, the cause for Pulmonary Hypertension should be coded first.

  • Group 1 is caused by drug toxicity from drugs such as appetite suppressants, or a condition such as HIV, Portal Hypertension, or Congenital Heart Disease.
  • Group 2 refers to left heart disease associated or cardiac valve diseases.
  • Group 3 is related to respiratory diseases such as Cystic Fibrosis, Interstitial Lung Disease, Sleep Apnea, Pleural Effusion, or Bronchiectasis.
  • Group 4 is related to Pulmonary Embolism.
  • Group 5 is used if there are multiple, but unclear factors that led to Pulmonary Hypertension, or hematologic, metabolic or systemic disorders.

Eisenmenger’s Syndrome

Eisenmenger’s Syndrome is any untreated congenital cardiac defect with intracardiac communication that leads to pulmonary hypertension, reversal of flow, and cyanosis. This is related to a congenital heart defect, causing right to left shunt to be irreversible.  It is represented by new code 127.83.  When coding for Eisenmenger’s Syndrome, the Q code for heart defect should be coded first.

Myocardial Infarction

Myocardial Infarction or more commonly known as a heart attack also is an ailment covered in Chapter 9.  When coding for Myocardial Infarction you must consider whether to code it as NSTEMI or STEMI.  NSTEMI is the complete blockage of a minor coronary artery or partial blockage of a major coronary artery causing partial damage to the heart muscle.  About 30 percent of Myocardial Infractions are Non STEMI. This is also categorized as Non-Transmural as it does not extend through all thicknesses of the heart muscle.  While STEMI is the complete occlusion of a major coronary artery due to atherosclerosis.  This is transmural and damages the full thickness of the heart muscle including the endocardium, myocardium and epicardium layers of the heart muscle.  The remaining 70 percent of Myocardial Infarction are STEMI (this is the default if not documented).

Before we cover the Myocardial Infarction codes, below is a listing of the sub-types:

  • Type 1 ‐ MI related to ischemia from a primary coronary event (e.g., plaque rupture, thrombotic occlusion).
  • Type 2 ‐ MI secondary to demand ischemia and coded as NSTEMI unless documented otherwise.

The following types are all associated with a revascularization procedure and should follow the causal code.  The “Code also” and “Code first” notes should be followed related to complications, and for coding of postprocedural Myocardial Infarctions during or following cardiac surgery.

  • Type 3 ‐ MI resulting in sudden cardiac death.
  • Type 4a ‐ MI associated with percutaneous coronary intervention.
  • Type 4b ‐ MI associated with in‐stent thrombosis.
  • Type 5 ‐ MI associated with coronary artery bypass surgery.

Below are the codes related to Myocardial Infarction:

  • 0 through I21.3 – All Type 1 STEMI
  • 4 – Type 1 Non‐STEMI and nontransmural or subendocardial acute MIs.
  • 9 – Default for an acute MI NOS, initial MI with no documentation of type or site.
  • A1 – Type 2 myocardial infarction due to demand ischemia. “Code also” the underlying cause (Type 2 MIs are not caused by atherosclerotic plaque).
  • A9 – Other (Type 3,4, and 5) are associated with a revascularization procedure and follow another code for the procedure or complication.

Heat Failure 

Heart Failure is also covered in Chapter 9.  All heart failure codes are inclusive of any pulmonary edema, so they should not be coded separately. The heart failure codes are detailed below:

  • 1 – Left ventricular failure or left heart failure. The heart does not completely relax, and the ventricles do not fill.
  • 2‐ Systolic (congestive)heart failure means the heart does not contract fully; therefore, not enough blood is pushed out.
  • 3 ‐ Diastolic (congestive) heart failure.
  • 4 ‐ Combined systolic (congestive) and diastolic (congestive) heart failure.
  • 81 – Right heart failure.
  • 82 – Biventricular heart failure.
  • 83 – High output heart failure.
  • 84 – End stage heart failure.
  • 89 – Other heart failure. Note: Code the type of heart failure, if known.
  • 9 – Heart failure, unspecified.

Below are the stages that correspond with the codes above:

  • Stage A heart disease – The patient does not have heart failure, but is at risk for heart failure. Code is Z91.89
  • Stage B heart disease – Heart disease is present, but there are no symptoms presently.
  • Stage C heart disease – Structural changes in the heart and symptoms are present.
  • Stage D heart failure – End stage heart failure – I50.84.

Overwhelmed?  We can Help!

This blog is just an overview of Chapter 9. Your team may be overwhelmed by this amount of information as well as the other 2018 ICD-10 changes.  However, our highly skilled staff can assist in many different areas.  Our certified RN coders can work with your clinicians to ensure your coding is compliant, accurate and results in maximum reimbursement.  We also offer many onsite as well as remote training options. Finally, your team can gain valuable knowledge from our many manual and DVD options.  For further information, please contact us at [email protected] or 866-428-4040.

2018 ICD-10 Code Changes for Diseases of the Circulatory System
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