Important ICD 10 CODE FOR Atherosclerosis, Ischemia and Infarction

Selected Atherosclerosis, Ischemia, and Infarction (ICD-9-CM 410.00 to 410.92 Range, 411.1, 412, 413.0, 413.1, 413.9, 414.00 to 414.07 Range, 414.10, 414.11, 414.12, 414.19, 414.2, 414.3, 414.4, 414.8, 414.9, 429.2, 429.5, 429.6, 429.71, 429.79) 

I21.01 ST elevation (STEMI) myocardial infarction involving left main coronary artery
I21.02 ST elevation (STEMI) myocardial infarction involving left anterior descending coronary artery
I21.09 ST elevation (STEMI) myocardial infarction involving other coronary artery of anterior wall
 I21.11 ST elevation (STEMI) myocardial infarction involving right coronary artery
 I21.19 ST elevation (STEMI) myocardial infarction involving other coronary artery of inferior wall
 I21.21 ST elevation (STEMI) myocardial infarction involving left circumflex coronary artery
 I21.29 ST elevation (STEMI) myocardial infarction involving other sites
I21.3 ST elevation (STEMI) myocardial infarction of unspecified site
 I21.4 Non-ST elevation (NSTEMI) myocardial infarction
 I22.0 Subsequent ST elevation (STEMI) myocardial infarction of anterior wall
 I22.1 Subsequent ST elevation (STEMI) myocardial infarction of inferior wall
 I22.2 Subsequent non-ST elevation (NSTEMI) myocardial infarction
 I22.8 Subsequent ST elevation (STEMI) myocardial infarction of other sites
 I22.9 Subsequent ST elevation (STEMI) myocardial infarction of unspecified site
I23.0 Hemopericardium as current complication following acute myocardial infarction
 I23.1 Atrial septal defect as current complication following acute myocardial infarction
 I23.2 Ventricular septal defect as current complication following acute myocardial infarction
I23.3 Rupture of cardiac wall without hemopericardium as current complication following acute myocardial infarction
 I23.4 Rupture of chordae tendineae as current complication following acute myocardial infarction
 I23.5 Rupture of papillary muscle as current complication following acute myocardial infarction
 I23.6 Thrombosis of atrium, auricular appendage, and ventricle as current complications following acute myocardial infarction
I23.7 Postinfarction angina
 I23.8 Other current complications following acute myocardial infarction
 I25.10 Atherosclerotic heart disease of native coronary artery without angina pectoris
I25.110 Atherosclerotic heart disease of native coronary artery with unstable angina pectoris
I25.111 Atherosclerotic heart disease of native coronary artery with angina pectoris with documented spasm
I25.118 Atherosclerotic heart disease of native coronary artery with other forms of angina pectoris
 I25.119* Atherosclerotic heart disease of native coronary artery with unspecified angina pectoris
 I25.2 Old myocardial infarction
 I25.3 Aneurysm of heart
I25.41 Coronary artery aneurysm
 I25.42 Coronary artery dissection
I25.5 Ischemic cardiomyopathy
I25.6 Silent myocardial ischemia
 I25.700* Atherosclerosis of coronary artery bypass graft(s), unspecified, with unstable angina pectoris
 I25.701* Atherosclerosis of coronary artery bypass graft(s), unspecified, with angina pectoris with documented spasm
 I25.708* Atherosclerosis of coronary artery bypass graft(s), unspecified, with other
I25.709* Atherosclerosis of coronary artery bypass graft(s), unspecified, with unspecified angina pectoris
 I25.710 Atherosclerosis of autologous vein coronary artery bypass graft(s) with unstable angina pectoris
 I25.711 Atherosclerosis of autologous vein coronary artery bypass graft(s) with angina pectoris with documented spasm
 I25.718 Atherosclerosis of autologous vein coronary artery bypass graft(s) with other forms of angina pectoris

I25.719* Atherosclerosis of autologous vein coronary artery bypass graft(s) with unspecified angina pectoris
 I25.720 Atherosclerosis of autologous artery coronary artery bypass graft(s) with unstable angina pectoris
 I25.721 Atherosclerosis of autologous artery coronary artery bypass graft(s) with angina pectoris with documented spasm
I25.728 Atherosclerosis of autologous artery coronary artery bypass graft(s) with other forms of angina pectoris
 I25.729* Atherosclerosis of autologous artery coronary artery bypass graft(s) with unspecified angina pectoris
 I25.730 Atherosclerosis of nonautologous biological coronary artery bypass graft(s) with unstable angina pectoris
 I25.731 Atherosclerosis of nonautologous biological coronary artery bypass graft(s) with angina pectoris with documented spasm
 I25.738 Atherosclerosis of nonautologous biological coronary artery bypass graft(s) with other forms of angina pectoris
 I25.739* Atherosclerosis of nonautologous biological coronary artery bypass graft(s) with unspecified angina pectoris
I25.750 Atherosclerosis of native coronary artery of transplanted heart with unstable angina
I25.751 Atherosclerosis of native coronary artery of transplanted heart with angina pectoris with documented spasm
 I25.758 Atherosclerosis of native coronary artery of transplanted heart with other forms of angina pectoris
 I25.759* Atherosclerosis of native coronary artery of transplanted heart with unspecified angina pectoris
I25.760 Atherosclerosis of bypass graft of coronary artery of transplanted heart with unstable angina
 I25.761 Atherosclerosis of bypass graft of coronary artery of transplanted heart with angina pectoris with documented spasm
I25.768 Atherosclerosis of bypass graft of coronary artery of transplanted heart with other forms of angina pectoris
I25.769* Atherosclerosis of bypass graft of coronary artery of transplanted heart with unspecified angina pectoris
I25.790 Atherosclerosis of other coronary artery bypass graft(s) with unstable angina pectoris
 I25.791 Atherosclerosis of other coronary artery bypass graft(s) with angina pectoris with documented spasm
I25.798 Atherosclerosis of other coronary artery bypass graft(s) with other forms of angina pectoris
I25.799* Atherosclerosis of other coronary artery bypass graft(s) with unspecified angina pectoris
 I25.810 Atherosclerosis of coronary artery bypass graft(s) without angina pectoris
 I25.811 Atherosclerosis of native coronary artery of transplanted heart without angina pectoris
I25.812 Atherosclerosis of bypass graft of coronary artery of transplanted heart without angina pectoris
 I25.82 Chronic total occlusion of coronary artery
 I25.83 Coronary atherosclerosis due to lipid rich plaque
I25.84 Coronary atherosclerosis due to calcified coronary lesion
 I25.89 Other forms of chronic ischemic heart disease
I25.9* Chronic ischemic heart disease, unspecified

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

Chest pain and Heart Failure ICD 10 code

Chest Pain (ICD-9-CM 411.1, 413.1, 413.9, 786.50 to 786.59 Range) 

I20.0 Unstable angina
I20.1 Angina pectoris with documented spasm
I20.8 Other forms of angina pectoris
 I20.9 Angina pectoris, unspecified
 R07.1 Chest pain on breathing
 R07.2 Precordial pain
 R07.81 Pleurodynia
R07.82 Intercostal pain
R07.89 Other chest pain
R07.9* Chest pain, unspecified

Heart Failure (ICD-9-CM 428.0, 428.1, 428.20 to 428.23 Range, 428.30 TO 428.33 Range, 428.40 TO 428.43 Range, 428.9) 

I50.1 Left ventricular failure
 I50.20* Unspecified systolic (congestive) heart failure
 I50.21 Acute systolic (congestive) heart failure
 I50.22 Chronic systolic (congestive) heart failure
 I50.23 Acute on chronic systolic (congestive) heart failure
I50.30* Unspecified diastolic (congestive) heart failure
I50.31 Acute diastolic (congestive) heart failure
I50.32 Chronic diastolic (congestive) heart failure
 I50.33 Acute on chronic diastolic (congestive) heart failure
I50.40* Unspecified combined systolic (congestive) and diastolic (congestive) heart failure
 I50.41 Acute combined systolic (congestive) and diastolic (congestive) heart failure
 I50.42 Chronic combined systolic (congestive) and diastolic (congestive) heart failure
I50.43 Acute on chronic combined systolic (congestive) and diastolic (congestive) heart failure
I50.9* Heart failure, unspecified

Hypertension (ICD-9-CM 401.9)
I10 Essential (primary) hypertension

ICD 10 code for Heart rhythm and Atrial Fibrillation

Abnormalities of Heart Rhythm (ICD-9-CM 427.81, 427.89, 785.0, 785.1, 785.3) 


R00.0 Tachycardia, unspecified
 R00.1 Bradycardia, unspecified
 R00.2 Palpitations
 R00.8 Other abnormalities of heart beat
 R00.9* Unspecified abnormalities of heart beat
*Codes with a greater degree of specificity should be considered first.

Atrial Fibrillation and Flutter (ICD-9-CM 427.31, 427.32) 

I48.0 Paroxysmal atrial fibrillation
 I48.1 Persistent atrial fibrillation
 I48.2 Chronic atrial fibrillation
 I48.3 Typical atrial flutter
 I48.4 Atypical atrial flutter
 I48.91* Unspecified atrial fibrillation
I48.92* Unspecified atrial flutter


 Cardiac Arrhythmias (Other) (ICD-9-CM 427.41, 427.42, 427.60, 427.61, 427.69, 427.81, 427.89, 427.9) 

I49.01 Ventricular fibrillation
 I49.02 Ventricular flutter
 I49.1 Atrial premature depolarization
I49.2 Junctional premature depolarization
I49.3 Ventricular premature depolarization
I49.40 Unspecified premature depolarization
I49.49 Other premature depolarization
 I49.5 Sick sinus syndrome
I49.8 Other specified cardiac arrhythmias
 I49.9* Cardiac arrhythmia, unspecified

Diagnostic arteriography CPT 36200, 36245, 36251, G0278 and 75658 - COVERED ICD code

CPT/HCPCS Codes


Group 1 Codes
36200 Place catheter in aorta
36245 Ins cath abd/l-ext art 1st
36246 Ins cath abd/l-ext art 2nd
36247 Ins cath abd/l-ext art 3rd
36248 Ins cath abd/l-ext art addl
75625 Contrast exam abdominl aorta
75726 Artery x-rays abdomen

Group 2 Codes
36251 Ins cath ren art 1st unilat
36252 Ins cath ren art 1st bilat
36253 Ins cath ren art 2nd+ unilat
36254 Ins cath ren art 2nd+ bilat

Group 3 Codes
G0278 Iliac art angio,cardiac cath
75630 X-ray aorta leg arteries

Group 4 Codes
75658 Artery x-rays arm
75710 Artery x-rays arm/leg
75716 Artery x-rays arms/legs
36120 Establish access to artery
75600 Contrast exam thoracic aorta
75605 Contrast exam thoracic aorta
36200 Place catheter in aorta
36215 Place catheter in artery
36216 Place catheter in artery
36217 Place catheter in artery
36218 Place catheter in artery
36221 Place cath thoracic aorta
36222 Place cath carotid/inom art
36223 Place cath carotid/inom art
36224 Place cath carotd art
36225 Place cath subclavian art
36226 Place cath vertebral art
36227 Place cath xtrnl carotid
36228 Place cath intracranial art


ICD-10 Codes that Support Medical Necessity
For CPT codes 36245, 36246, 36247, 36248, 75625, and 75726
Group 1 Codes
C22.0 Liver cell carcinoma
C22.8 Malignant neoplasm of liver, primary, unspecified as to type
C22.9 Malignant neoplasm of liver, not specified as primary or secondary
C78.7 Secondary malignant neoplasm of liver and intrahepatic bile duct
C7B.02 Secondary carcinoid tumors of liver
I70.211 Atherosclerosis of native arteries of extremities with intermittent claudication, right leg
I70.212 Atherosclerosis of native arteries of extremities with intermittent claudication, left leg
I70.213 Atherosclerosis of native arteries of extremities with intermittent claudication, bilateral legs
I70.221 Atherosclerosis of native arteries of extremities with rest pain, right leg
I70.222 Atherosclerosis of native arteries of extremities with rest pain, left leg
I70.223 Atherosclerosis of native arteries of extremities with rest pain, bilateral legs
I70.231 Atherosclerosis of native arteries of right leg with ulceration of thigh
I70.232 Atherosclerosis of native arteries of right leg with ulceration of calf
I70.233 Atherosclerosis of native arteries of right leg with ulceration of ankle
I70.234 Atherosclerosis of native arteries of right leg with ulceration of heel and midfoot
I70.235 Atherosclerosis of native arteries of right leg with ulceration of other part of foot
I70.241 Atherosclerosis of native arteries of left leg with ulceration of thigh
I70.242 Atherosclerosis of native arteries of left leg with ulceration of calf
I70.243 Atherosclerosis of native arteries of left leg with ulceration of ankle
I70.244 Atherosclerosis of native arteries of left leg with ulceration of heel and midfoot
I70.245 Atherosclerosis of native arteries of left leg with ulceration of other part of foot
I70.261 Atherosclerosis of native arteries of extremities with gangrene, right leg
I70.262 Atherosclerosis of native arteries of extremities with gangrene, left leg
I70.263 Atherosclerosis of native arteries of extremities with gangrene, bilateral legs
I70.291 Other atherosclerosis of native arteries of extremities, right leg
I70.292 Other atherosclerosis of native arteries of extremities, left leg
I70.293 Other atherosclerosis of native arteries of extremities, bilateral legs
I70.411 Atherosclerosis of autologous vein bypass graft(s) of the extremities with intermittent claudication, right leg
I70.412 Atherosclerosis of autologous vein bypass graft(s) of the extremities with intermittent claudication, left leg
I70.413 Atherosclerosis of autologous vein bypass graft(s) of the extremities with intermittent claudication, bilateral legs
I70.421 Atherosclerosis of autologous vein bypass graft(s) of the extremities with rest pain, right leg
I70.422 Atherosclerosis of autologous vein bypass graft(s) of the extremities with rest pain, left leg
I70.423 Atherosclerosis of autologous vein bypass graft(s) of the extremities with rest pain, bilateral legs
I70.431 Atherosclerosis of autologous vein bypass graft(s) of the right leg with ulceration of thigh
I70.432 Atherosclerosis of autologous vein bypass graft(s) of the right leg with ulceration of calf
I70.433 Atherosclerosis of autologous vein bypass graft(s) of the right leg with ulceration of ankle
I70.434 Atherosclerosis of autologous vein bypass graft(s) of the right leg with ulceration of heel and midfoot
I70.435 Atherosclerosis of autologous vein bypass graft(s) of the right leg with ulceration of other part of foot
I70.441 Atherosclerosis of autologous vein bypass graft(s) of the left leg with ulceration of thigh
I70.442 Atherosclerosis of autologous vein bypass graft(s) of the left leg with ulceration of calf
I70.443 Atherosclerosis of autologous vein bypass graft(s) of the left leg with ulceration of ankle
I70.444 Atherosclerosis of autologous vein bypass graft(s) of the left leg with ulceration of heel and midfoot
I70.445 Atherosclerosis of autologous vein bypass graft(s) of the left leg with ulceration of other part of foot
I70.461 Atherosclerosis of autologous vein bypass graft(s) of the extremities with gangrene, right leg
I70.462 Atherosclerosis of autologous vein bypass graft(s) of the extremities with gangrene, left leg
I70.463 Atherosclerosis of autologous vein bypass graft(s) of the extremities with gangrene, bilateral legs
I70.491 Other atherosclerosis of autologous vein bypass graft(s) of the extremities, right leg
I70.492 Other atherosclerosis of autologous vein bypass graft(s) of the extremities, left leg
I70.493 Other atherosclerosis of autologous vein bypass graft(s) of the extremities, bilateral legs
I70.511 Atherosclerosis of nonautologous biological bypass graft(s) of the extremities with intermittent claudication, right leg
I70.512 Atherosclerosis of nonautologous biological bypass graft(s) of the extremities with intermittent claudication, left leg
I70.513 Atherosclerosis of nonautologous biological bypass graft(s) of the extremities with intermittent claudication, bilateral legs
I70.521 Atherosclerosis of nonautologous biological bypass graft(s) of the extremities with rest pain, right leg
I70.522 Atherosclerosis of nonautologous biological bypass graft(s) of the extremities with rest pain, left leg
I70.523 Atherosclerosis of nonautologous biological bypass graft(s) of the extremities with rest pain, bilateral legs
I70.531 Atherosclerosis of nonautologous biological bypass graft(s) of the right leg with ulceration of thigh
I70.532 Atherosclerosis of nonautologous biological bypass graft(s) of the right leg with ulceration of calf
I70.533 Atherosclerosis of nonautologous biological bypass graft(s) of the right leg with ulceration of ankle
I70.534 Atherosclerosis of nonautologous biological bypass graft(s) of the right leg with ulceration of heel and midfoot
I70.535 Atherosclerosis of nonautologous biological bypass graft(s) of the right leg with ulceration of other part of foot
I70.541 Atherosclerosis of nonautologous biological bypass graft(s) of the left leg with ulceration of thigh
I70.542 Atherosclerosis of nonautologous biological bypass graft(s) of the left leg with ulceration of calf
I70.543 Atherosclerosis of nonautologous biological bypass graft(s) of the left leg with ulceration of ankle
I70.544 Atherosclerosis of nonautologous biological bypass graft(s) of the left leg with ulceration of heel and midfoot
I70.545 Atherosclerosis of nonautologous biological bypass graft(s) of the left leg with ulceration of other part of foot
I70.561 Atherosclerosis of nonautologous biological bypass graft(s) of the extremities with gangrene, right leg
I70.562 Atherosclerosis of nonautologous biological bypass graft(s) of the extremities with gangrene, left leg
I70.563 Atherosclerosis of nonautologous biological bypass graft(s) of the extremities with gangrene, bilateral legs
I70.591 Other atherosclerosis of nonautologous biological bypass graft(s) of the extremities, right leg
I70.592 Other atherosclerosis of nonautologous biological bypass graft(s) of the extremities, left leg
I70.593 Other atherosclerosis of nonautologous biological bypass graft(s) of the extremities, bilateral legs
I70.611 Atherosclerosis of nonbiological bypass graft(s) of the extremities with intermittent claudication, right leg
I70.612 Atherosclerosis of nonbiological bypass graft(s) of the extremities with intermittent claudication, left leg
I70.613 Atherosclerosis of nonbiological bypass graft(s) of the extremities with intermittent claudication, bilateral legs
I70.621 Atherosclerosis of nonbiological bypass graft(s) of the extremities with rest pain, right leg
I70.622 Atherosclerosis of nonbiological bypass graft(s) of the extremities with rest pain, left leg
I70.623 Atherosclerosis of nonbiological bypass graft(s) of the extremities with rest pain, bilateral legs
I70.631 Atherosclerosis of nonbiological bypass graft(s) of the right leg with ulceration of thigh
I70.632 Atherosclerosis of nonbiological bypass graft(s) of the right leg with ulceration of calf
I70.633 Atherosclerosis of nonbiological bypass graft(s) of the right leg with ulceration of ankle
I70.634 Atherosclerosis of nonbiological bypass graft(s) of the right leg with ulceration of heel and midfoot
I70.635 Atherosclerosis of nonbiological bypass graft(s) of the right leg with ulceration of other part of foot
I70.641 Atherosclerosis of nonbiological bypass graft(s) of the left leg with ulceration of thigh
I70.642 Atherosclerosis of nonbiological bypass graft(s) of the left leg with ulceration of calf
I70.643 Atherosclerosis of nonbiological bypass graft(s) of the left leg with ulceration of ankle
I70.644 Atherosclerosis of nonbiological bypass graft(s) of the left leg with ulceration of heel and midfoot
I70.645 Atherosclerosis of nonbiological bypass graft(s) of the left leg with ulceration of other part of foot
I70.661 Atherosclerosis of nonbiological bypass graft(s) of the extremities with gangrene, right leg
I70.662 Atherosclerosis of nonbiological bypass graft(s) of the extremities with gangrene, left leg
I70.663 Atherosclerosis of nonbiological bypass graft(s) of the extremities with gangrene, bilateral legs
I70.691 Other atherosclerosis of nonbiological bypass graft(s) of the extremities, right leg
I70.692 Other atherosclerosis of nonbiological bypass graft(s) of the extremities, left leg
I70.693 Other atherosclerosis of nonbiological bypass graft(s) of the extremities, bilateral legs
I70.711 Atherosclerosis of other type of bypass graft(s) of the extremities with intermittent claudication, right leg
I70.712 Atherosclerosis of other type of bypass graft(s) of the extremities with intermittent claudication, left leg
I70.713 Atherosclerosis of other type of bypass graft(s) of the extremities with intermittent claudication, bilateral legs
I70.721 Atherosclerosis of other type of bypass graft(s) of the extremities with rest pain, right leg
I70.722 Atherosclerosis of other type of bypass graft(s) of the extremities with rest pain, left leg
I70.723 Atherosclerosis of other type of bypass graft(s) of the extremities with rest pain, bilateral legs
I70.731 Atherosclerosis of other type of bypass graft(s) of the right leg with ulceration of thigh
I70.732 Atherosclerosis of other type of bypass graft(s) of the right leg with ulceration of calf
I70.733 Atherosclerosis of other type of bypass graft(s) of the right leg with ulceration of ankle
I70.734 Atherosclerosis of other type of bypass graft(s) of the right leg with ulceration of heel and midfoot
I70.735 Atherosclerosis of other type of bypass graft(s) of the right leg with ulceration of other part of foot
I70.741 Atherosclerosis of other type of bypass graft(s) of the left leg with ulceration of thigh
I70.742 Atherosclerosis of other type of bypass graft(s) of the left leg with ulceration of calf
I70.743 Atherosclerosis of other type of bypass graft(s) of the left leg with ulceration of ankle
I70.744 Atherosclerosis of other type of bypass graft(s) of the left leg with ulceration of heel and midfoot
I70.745 Atherosclerosis of other type of bypass graft(s) of the left leg with ulceration of other part of foot
I70.761 Atherosclerosis of other type of bypass graft(s) of the extremities with gangrene, right leg
I70.762 Atherosclerosis of other type of bypass graft(s) of the extremities with gangrene, left leg
I70.763 Atherosclerosis of other type of bypass graft(s) of the extremities with gangrene, bilateral legs
I70.791 Other atherosclerosis of other type of bypass graft(s) of the extremities, right leg
I70.792 Other atherosclerosis of other type of bypass graft(s) of the extremities, left leg
I70.793 Other atherosclerosis of other type of bypass graft(s) of the extremities, bilateral legs
I71.4 Abdominal aortic aneurysm, without rupture
I71.6 Thoracoabdominal aortic aneurysm, without rupture
I72.4 Aneurysm of artery of lower extremity
I73.89 Other specified peripheral vascular diseases
I73.9 Peripheral vascular disease, unspecified
I74.09 Other arterial embolism and thrombosis of abdominal aorta
I74.5 Embolism and thrombosis of iliac artery
I77.1 Stricture of artery
I77.4 Celiac artery compression syndrome
I77.811 Abdominal aortic ectasia
I77.812 Thoracoabdominal aortic ectasia
I79.0 Aneurysm of aorta in diseases classified elsewhere
I79.1 Aortitis in diseases classified elsewhere
I79.8 Other disorders of arteries, arterioles and capillaries in diseases classified elsewhere
K55.0 Acute vascular disorders of intestine
K55.21 Angiodysplasia of colon with hemorrhage
K91.61 Intraoperative hemorrhage and hematoma of a digestive system organ or structure complicating a digestive sytem procedure
K91.62 Intraoperative hemorrhage and hematoma of a digestive system organ or structure complicating other procedure
K91.840 Postprocedural hemorrhage and hematoma of a digestive system organ or structure following a digestive system procedure
K91.841 Postprocedural hemorrhage and hematoma of a digestive system organ or structure following other procedure
K92.1 Melena
K92.2 Gastrointestinal hemorrhage, unspecified
Q27.33 Arteriovenous malformation of digestive system vessel
S35.01XA Minor laceration of abdominal aorta, initial encounter
S35.01XD Minor laceration of abdominal aorta, subsequent encounter
S35.01XS Minor laceration of abdominal aorta, sequela
S35.02XA Major laceration of abdominal aorta, initial encounter
S35.02XD Major laceration of abdominal aorta, subsequent encounter
S35.02XS Major laceration of abdominal aorta, sequela
S35.09XA Other injury of abdominal aorta, initial encounter
S35.09XD Other injury of abdominal aorta, subsequent encounter
S35.09XS Other injury of abdominal aorta, sequela
S35.511A Injury of right iliac artery, initial encounter
S35.511D Injury of right iliac artery, subsequent encounter
S35.511S Injury of right iliac artery, sequela
S35.512A Injury of left iliac artery, initial encounter
S35.512D Injury of left iliac artery, subsequent encounter
S35.512S Injury of left iliac artery, sequela
S36.114A Minor laceration of liver, initial encounter
S36.114D Minor laceration of liver, subsequent encounter
S36.114S Minor laceration of liver, sequela
S36.115A Moderate laceration of liver, initial encounter
S36.115D Moderate laceration of liver, subsequent encounter
S36.115S Moderate laceration of liver, sequela
S36.116A Major laceration of liver, initial encounter
S36.116D Major laceration of liver, subsequent encounter
S36.116S Major laceration of liver, sequela
S36.118A Other injury of liver, initial encounter
S36.118D Other injury of liver, subsequent encounter
S36.118S Other injury of liver, sequela


Group 2 Paragraph
For CPT codes 36251, 36252, 36253, and 36254
Group 2 Codes
C64.1 Malignant neoplasm of right kidney, except renal pelvis
C64.2 Malignant neoplasm of left kidney, except renal pelvis
C74.01 Malignant neoplasm of cortex of right adrenal gland
C74.02 Malignant neoplasm of cortex of left adrenal gland
C74.11 Malignant neoplasm of medulla of right adrenal gland
C74.12 Malignant neoplasm of medulla of left adrenal gland
C79.01 Secondary malignant neoplasm of right kidney and renal pelvis
C79.02 Secondary malignant neoplasm of left kidney and renal pelvis
D30.01 Benign neoplasm of right kidney
D30.02 Benign neoplasm of left kidney
D30.11 Benign neoplasm of right renal pelvis
D30.12 Benign neoplasm of left renal pelvis
I10 Essential (primary) hypertension
I12.0 Hypertensive chronic kidney disease with stage 5 chronic kidney disease or end stage renal disease
I12.9 Hypertensive chronic kidney disease with stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease
I13.0 Hypertensive heart and chronic kidney disease with heart failure and stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease
I13.10 Hypertensive heart and chronic kidney disease without heart failure, with stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease
I13.11 Hypertensive heart and chronic kidney disease without heart failure, with stage 5 chronic kidney disease, or end stage renal disease
I13.2 Hypertensive heart and chronic kidney disease with heart failure and with stage 5 chronic kidney disease, or end stage renal disease
I15.0 Renovascular hypertension
I15.1 Hypertension secondary to other renal disorders
I70.1 Atherosclerosis of renal artery
I72.2 Aneurysm of renal artery
N26.2 Page kidney
N28.0 Ischemia and infarction of kidney
Q27.1 Congenital renal artery stenosis
Q27.2 Other congenital malformations of renal artery
Q27.34 Arteriovenous malformation of renal vessel
R31.0 Gross hematuria
R31.1 Benign essential microscopic hematuria
R31.2 Other microscopic hematuria
R94.4 Abnormal results of kidney function studies
S35.411A Laceration of right renal artery, initial encounter
S35.411D Laceration of right renal artery, subsequent encounter
S35.411S Laceration of right renal artery, sequela
S35.412A Laceration of left renal artery, initial encounter
S35.412D Laceration of left renal artery, subsequent encounter
S35.412S Laceration of left renal artery, sequela
S35.491A Other specified injury of right renal artery, initial encounter
S35.491D Other specified injury of right renal artery, subsequent encounter
S35.491S Other specified injury of right renal artery, sequela
S35.492A Other specified injury of left renal artery, initial encounter
S35.492D Other specified injury of left renal artery, subsequent encounter
S35.492S Other specified injury of left renal artery, sequela


Group 3 Paragraph
For HCPCS/CPT codes 75630 and G0278
Group 3 Codes
I72.4 Aneurysm of artery of lower extremity
I73.89 Other specified peripheral vascular diseases
I73.9 Peripheral vascular disease, unspecified
S35.511A Injury of right iliac artery, initial encounter
S35.511D Injury of right iliac artery, subsequent encounter
S35.511S Injury of right iliac artery, sequela
S35.512A Injury of left iliac artery, initial encounter
S35.512D Injury of left iliac artery, subsequent encounter
S35.512S Injury of left iliac artery, sequela

Vascular Stenting CPT codes 37221 - 37235 - covered ICD codes

Coverage Indications, Limitations, and/or Medical Necessity

Vascular stenting of lower extremity arteries performed for clinically significant occlusive vascular disease will be considered medically reasonable and necessary for a patient under any of the following circumstances:
Primary therapy for common iliac artery stenosis and occlusions.
Primary therapy for external iliac artery stenoses and occlusions.
Primary therapy for femoral/popliteal arterial stenosis and occlusions.
Salvage therapy for common and external iliac arteries for a suboptimal or failed result from balloon dilation (e.g., persistent translesional gradient, residual diameter stenosis greater than 50%, or flow-limiting dissection).
Salvage therapy for femoral/popliteal arteries for a suboptimal or failed result from balloon dilation (e.g., persistent translesional gradient, residual diameter stenosis greater than 50%, or flow-limiting dissection).
Salvage therapy for tibial/peroneal arterial lesions for a suboptimal result from ballon dilation.


Limitations

Vascular stenting of lower extremity arteries is considered experimental and investigational for a patient under any of the following circumstances as the effectiveness has not been well established and/or is not recommended, and therefore, will not be considered medically reasonable and necessary:
Primary therapy for tibial/peroneal arterial stenosis and occlusions.
It is the expectation that for the covered indications of this policy, the utilized stent will have Food and Drug Administration (FDA) approval for that indication. ‘Off-label use’ of drug-eluting stents and polytetrafluoroethylene (PTFE)-covered stents are non-covered (given the FDA approved use as well as off-label use of such devices is a subject of on-going clinical trials). For the covered indications, a stent approved by the FDA may be covered for off-label use for which efficacy has been supported in peer-reviewed medical literature, given that there are no FDA-contraindications or warnings which have been demonstrated in this regard and given that its use has been a long standing standard of care (this statement is limited to vascular stents for lower extremity arteries as applied to this LCD).

Revenue Codes
Code Description
0320 Radiology - Diagnostic - General Classification
0320 Radiology - Diagnostic - General Classification
0321 Radiology - Diagnostic - Angiocardiography
0322 Radiology - Diagnostic - Arthrography
0323 Radiology - Diagnostic - Arteriography
0323 Radiology - Diagnostic - Arteriography
0324 Radiology - Diagnostic - Chest X-Ray
0329 Radiology - Diagnostic - Other Radiology - Diagnostic
0329 Radiology - Diagnostic - Other Radiology - Diagnostic
0340 Nuclear Medicine - General Classification
0342 Nuclear Medicine - Therapeutic
0349 Nuclear Medicine - Other Nuclear Medicine
0350 CT Scan - General Classification
0351 CT Scan - Head Scan
0352 CT Scan - Body Scan
0359 CT Scan - CT - Other
0402 Other Imaging Services - Ultrasound
0404 Other Imaging Services - Positron Emission Tomography
0409 Other Imaging Services - Other Imaging Services
0610 Magnetic Resonance Technology (MRT) - General Classification
0614 Magnetic Resonance Technology (MRT) - MRI - Other
0615 Magnetic Resonance Technology (MRT) - MRA - Head and Neck
0616 Magnetic Resonance Technology (MRT) - MRA - Lower Extremities
0618 Magnetic Resonance Technology (MRT) - MRA - Other
0619 Magnetic Resonance Technology (MRT) - Other MRT

CPT/HCPCS Codes

Group 1 Codes
37221 Iliac revasc w/stent
37223 Iliac revasc w/stent add-on
37226 Fem/popl revasc w/stent
37227 Fem/popl revasc stnt & ather
37230 Tib/per revasc w/stent
37231 Tib/per revasc stent & ather
37234 Revsc opn/prq tib/pero stent
37235 Tib/per revasc stnt & ather



ICD-10 Codes that Support Medical Necessity

I70.201 Unspecified atherosclerosis of native arteries of extremities, right leg
I70.202 Unspecified atherosclerosis of native arteries of extremities, left leg
I70.203 Unspecified atherosclerosis of native arteries of extremities, bilateral legs
I70.209 Unspecified atherosclerosis of native arteries of extremities, unspecified extremity
I70.211 Atherosclerosis of native arteries of extremities with intermittent claudication, right leg
I70.212 Atherosclerosis of native arteries of extremities with intermittent claudication, left leg
I70.213 Atherosclerosis of native arteries of extremities with intermittent claudication, bilateral legs
I70.219 Atherosclerosis of native arteries of extremities with intermittent claudication, unspecified extremity
I70.221 Atherosclerosis of native arteries of extremities with rest pain, right leg
I70.222 Atherosclerosis of native arteries of extremities with rest pain, left leg
I70.223 Atherosclerosis of native arteries of extremities with rest pain, bilateral legs
I70.229 Atherosclerosis of native arteries of extremities with rest pain, unspecified extremity
I70.231 Atherosclerosis of native arteries of right leg with ulceration of thigh
I70.232 Atherosclerosis of native arteries of right leg with ulceration of calf
I70.233 Atherosclerosis of native arteries of right leg with ulceration of ankle
I70.234 Atherosclerosis of native arteries of right leg with ulceration of heel and midfoot
I70.235 Atherosclerosis of native arteries of right leg with ulceration of other part of foot
I70.238 Atherosclerosis of native arteries of right leg with ulceration of other part of lower right leg
I70.239 Atherosclerosis of native arteries of right leg with ulceration of unspecified site
I70.241 Atherosclerosis of native arteries of left leg with ulceration of thigh
I70.242 Atherosclerosis of native arteries of left leg with ulceration of calf
I70.243 Atherosclerosis of native arteries of left leg with ulceration of ankle
I70.244 Atherosclerosis of native arteries of left leg with ulceration of heel and midfoot
I70.245 Atherosclerosis of native arteries of left leg with ulceration of other part of foot
I70.248 Atherosclerosis of native arteries of left leg with ulceration of other part of lower left leg
I70.249 Atherosclerosis of native arteries of left leg with ulceration of unspecified site
I70.261 Atherosclerosis of native arteries of extremities with gangrene, right leg
I70.262 Atherosclerosis of native arteries of extremities with gangrene, left leg
I70.263 Atherosclerosis of native arteries of extremities with gangrene, bilateral legs
I70.268 Atherosclerosis of native arteries of extremities with gangrene, other extremity
I70.269 Atherosclerosis of native arteries of extremities with gangrene, unspecified extremity
I73.9 Peripheral vascular disease, unspecified
I74.3 Embolism and thrombosis of arteries of the lower extremities
I74.5 Embolism and thrombosis of iliac artery
I74.8 Embolism and thrombosis of other arteries
I77.1 Stricture of artery
I77.72 Dissection of iliac artery
T81.718A Complication of other artery following a procedure, not elsewhere classified, initial encounter
T81.718D Complication of other artery following a procedure, not elsewhere classified, subsequent encounter
T81.718S Complication of other artery following a procedure, not elsewhere classified, sequela
T81.719A Complication of unspecified artery following a procedure, not elsewhere classified, initial encounter
T81.719D Complication of unspecified artery following a procedure, not elsewhere classified, subsequent encounter
T81.719S Complication of unspecified artery following a procedure, not elsewhere classified, sequela

Dual pacemaker CPT 33208 , 33227 - Covered ICD code

Initial dual chamber pacemaker system implantation

33208 Insertion of new or replacement of permanent pacemaker with transvenous electrode(s); atrial and ventricular


Possible Hospital Inpatient ICD-10-PCS Codes

02H64JZ Insertion of Pacemaker Lead into Right Atrium, Percutaneous Endoscopic Approach

02H63JZ Insertion of Pacemaker Lead into Right Atrium, Percutaneous Approach

02HK4JZ Insertion of Pacemaker Lead into Right Ventricle, Percutaneous Endoscopic Approach

02HK3JZ Insertion of Pacemaker Lead into Right Ventricle, Percutaneous Approach

0JH606Z Insertion of Pacemaker, Dual Chamber into Chest Subcutaneous Tissue and Fascia, Open Approach

0JH636Z Insertion of Pacemaker, Dual Chamber into Chest Subcutaneous Tissue and Fascia, Percutaneous Approach

0JH806Z Insertion of Pacemaker, Dual Chamber into Abdomen Subcutaneous Tissue and Fascia, Open Approach

0JH836Z Insertion of Pacemaker, Dual Chamber into Abdomen Subcutaneous Tissue and Fascia, Percutaneous Approach


Initial dual chamber pacemaker insertion with external cardioversion performed prior to device implant session for treatment of patient in atrial fibrillation

33208 Insertion of new or replacement of permanent pacemaker with transvenous electrode(s); atrial and ventricular
92960-59,


Possible Hospital Inpatient ICD-10-PCS Codes

0JH606Z Insertion of Pacemaker, Dual Chamber into Chest Subcutaneous Tissue and Fascia, Open Approach

0JH636Z Insertion of Pacemaker, Dual Chamber into Chest Subcutaneous Tissue and Fascia, Percutaneous Approach

0JH806Z Insertion of Pacemaker, Dual Chamber into Abdomen Subcutaneous Tissue and Fascia, Open Approach

0JH836Z Insertion of Pacemaker, Dual Chamber into Abdomen Subcutaneous Tissue and Fascia, Percutaneous Approach

02H64JZ Insertion of Pacemaker Lead into Right Atrium, Percutaneous Endoscopic Approach

02H63JZ Insertion of Pacemaker Lead into Right Atrium, Percutaneous Approach

02HK4JZ Insertion of Pacemaker Lead into Right Ventricle, Percutaneous Endoscopic Approach

02HK3JZ Insertion of Pacemaker Lead into Right Ventricle, Percutaneous Approach

5A2204Z Restoration of Cardiac Rhythm

33227 Removal of permanent pacemaker pulse generator with replacement of pacemaker pulse generator; single lead system

Possible Hospital Inpatient ICD-10-PCS Codes

0JH605Z Insertion of Pacemaker, Single Chamber Rate Responsive into Chest Subcutaneous Tissue and Fascia, Open Approach
0JH635Z Insertion of Pacemaker, Single Chamber Rate Responsive into Chest Subcutaneous Tissue and Fascia, Percutaneous Approach
0JH805Z Insertion of Pacemaker, Single Chamber Rate Responsive into Abdomen Subcutaneous Tissue and Fascia, Open Approach
0JH835Z Insertion of Pacemaker, Single Chamber Rate Responsive into Abdomen Subcutaneous Tissue and Fascia,
Percutaneous Approach
0JPT0PZ Removal of Cardiac Rhythm Related Device from Trunk Subcutaneous Tissue and Fascia, Open Approach
0JPT3PZ Removal of Cardiac Rhythm Related Device from Trunk Subcutaneous Tissue and Fascia, Percutaneous Approach

CPT CODE 33206 , 33207 & 33227 - COVERED ICD code

Initial single chamber rate-responsive pacemaker system implant with right atrial lead



33206 Insertion of new or replacement of permanent pacemaker with transvenous electrode(s); atrial

Possible Hospital Inpatient ICD-10-PCS Codes3

02H64JZ Insertion of Pacemaker Lead into Right Atrium, Percutaneous Endoscopic Approach

02H63JZ Insertion of Pacemaker Lead into Right Atrium, Percutaneous Approach

0JH605Z Insertion of Pacemaker, Single Chamber Rate Responsive into Chest Subcutaneous Tissue and Fascia, Open Approach

0JH635Z Insertion of Pacemaker, Single Chamber Rate Responsive into Chest Subcutaneous Tissue and Fascia, Percutaneous Approach

0JH805Z Insertion of Pacemaker, Single Chamber Rate Responsive into Abdomen Subcutaneous Tissue and Fascia, Open Approach

0JH835Z Insertion of Pacemaker, Single Chamber Rate Responsive into Abdomen Subcutaneous Tissue and Fascia, Percutaneous Approach





Initial single chamber rate-responsive pacemaker system implant with right ventricular lead

33207 Insertion of new or replacement of permanent pacemaker with transvenous electrode(s); ventricular



Possible Hospital Inpatient ICD-10-PCS Codes

02HK3JZ Insertion of Pacemaker Lead into Right Ventricle, Percutaneous Approach

02HK4JZ Insertion of Pacemaker Lead into Right Ventricle, Percutaneous Endoscopic Approach

0JH605Z Insertion of Pacemaker, Single Chamber Rate Responsive into Chest Subcutaneous Tissue and Fascia, Open Approach

0JH635Z Insertion of Pacemaker, Single Chamber Rate Responsive into Chest Subcutaneous Tissue and Fascia, Percutaneous Approach

0JH805Z Insertion of Pacemaker, Single Chamber Rate Responsive into Abdomen Subcutaneous Tissue and Fascia, Open Approach

0JH835Z Insertion of Pacemaker, Single Chamber Rate Responsive into Abdomen Subcutaneous Tissue and Fascia, Percutaneous Approach



Replacement of single chamber rate-responsive pulse generator



33227 Removal of permanent pacemaker pulse generator with replacement of pacemaker pulse generator; single lead system

Possible Hospital Inpatient ICD-10-PCS Codes3

0JH605Z Insertion of Pacemaker, Single Chamber Rate Responsive into Chest Subcutaneous Tissue and Fascia, Open Approach

0JH635Z Insertion of Pacemaker, Single Chamber Rate Responsive into Chest Subcutaneous Tissue and Fascia, Percutaneous Approach

0JH805Z Insertion of Pacemaker, Single Chamber Rate Responsive into Abdomen Subcutaneous Tissue and Fascia, Open Approach

0JH835Z Insertion of Pacemaker, Single Chamber Rate Responsive into Abdomen Subcutaneous Tissue and Fascia,