ICD 10 - Three main category of changes - Example coding

Specifying anatomical location and laterality required by ICD-10 is easier than you think. This detail reflects how physicians and clinicians communicate and to what they pay attention - it is a matter of ensuring the information is captured in your documentation.

In ICD-10-CM, there are three main categories of changes: 

Definition Changes

Terminology Differences

Increased Specificity

For cardiology, the focus is increased specificity and documenting the downstream effects of the patient’s condition.

ACUTE MYOCARDIAL INFARCTION (AMI) 

Definition Change 

When documenting hypertension, include the following:


 1. Timeframe            An AMI is now considered “acute” for 4 weeks from the time of the incident, a    revised timeframe from the current ICD-9 period of 8 weeks.


2. Episode of care            ICD-10 does not capture episode of care (e.g. initial,  subsequent, sequelae).


3. Subsequent AMI ICD-10 Code Examples      ICD-10 allows coding of a new MI that occurs during the 4 week “acute period” of the original AMI.

ICD code Example

I21.02 ST elevation (STEMI) myocardial infarction involving left anterior descending coronary artery

 I21.4 Non-ST elevation (NSTEMI) myocardial infarction

 I22.1 Subsequent ST elevation (STEMI) myocardial infarction of inferior wall



HYPERTENSION 
Definition Change 

In ICD-10, hypertension is defined as essential (primary). The concept of “benign or malignant” as it relates to hypertension no longer exists.

When documenting hypertension, include the following:

1. Type                                                e.g. essential, secondary, etc.

2. Causal relationship                     e.g. Renal, pulmonary, etc.


ICD-10 Code Examples 

I10 Essential (primary) hypertension

I11.9 Hypertensive heart disease without heart failure

I15.0 Renovascular hypertension


CONGESTIVE HEART FAILURE

Terminology Differences & Increased Specificity 

The terminology used in ICD-10 exactly matches the types of CHF. If you document “decompensation” or “exacerbation,” the CHF type will be coded as “acute on chronic.”
When documenting CHF, include the following:

 1. Cause                       e.g. Acute, chronic

2. Severity                  e.g. Systolic, diastolic

ICD 10 Example

 I50.23 Acute on chronic systolic (congestive) heart failure
 I50.33 Acute on chronic diastolic (congestive) heart failure
 I50.43 Acute on chronic combined systolic (congestive) and diastolic (congestive) heart failure




UNDERDOSING 

Terminology Difference 

Underdosing is an important new concept and term in ICD-10. It allows you to identify when a patient is taking less of a medication than is prescribed.

When documenting underdosing, include the following:

1. Intentional, Unintentional, Non-compliance                                                                                                   is the underdosing deliberate? (e.g., patient refusal)

2. Reason

Why is the patient not taking the medication? (e.g.financial hardship, age-related debility)



ICD 10 Example

Z91.120 Patient’s intentional underdosing of medication regimen due to financial hardship

 T36.4x6A Underdosing of tetracyclines, initial encounter

 T45.526D Underdosing of antithrombotic drugs, subsequent encounter





ATHEROSCLEROTIC HEART DISEASE WITH ANGINA PECTORIS 
Terminology Difference 

When documenting atherosclerotic heart disease with angina pectoris, include the following:

1. Cause
Assumed to be atherosclerosis; notate if there is another cause

2. Stability
e.g. Stable angina pectoris, unstable angina pectoris

3. Vessel

Note which artery (if known) is involved and whether the artery is native or autologous

4. Graft involvement
If appropriate, whether a bypass graft was involved in the angina pectoris diagnosis; also note the original location of the graft and whether it is autologous or biologic

ICD 10 Example

I25.110 Atherosclerotic heart disease of a native coronary artery with unstable angina pectoris

 I25.710 Atherosclerosis of autologous vein coronary artery bypass graft(s) with unstable angina pectoris



CARDIOMYOPATHY 
Increased Specificity 

When documenting cardiomyopathy, include the following, where appropriate:

1. Type
e.g. Dilated/congestive, obstructive or nonobstructive hypertrophic, etc.

2. Location
e.g. Endocarditis, right ventricle, etc.

3. Cause
e.g. Congenital, alcohol, etc.

List cardiomyopathy seen in other diseases such as gout, amyloidosis, etc.

ICD 10 Example

I42.0 Dilated cardiomyopathy

I42.1 Obstructive hypertrophic cardiomyopathy

I42.3 Endomyocardial (eosinophilic) disease




HEART VALVE DISEASE 
Increased Specificity 

ICD-10 assumes heart valve diseases are rheumatic; if this is not the case, notate otherwise.

When documenting heart valve disease, include the following:

1. Cause
e.g. Rheumatic or non-rheumatic

2. Type
e.g. Prolapse, insufficiency, regurgitation, incompetence, stenosis, etc.

3. Location
e.g. Mitral valve, aortic valve, etc.

ICD 10 Example

I06.2 Rheumatic aortic stenosis with insufficiency

 I34.1 Nonrheumatic mitral (valve) prolapse