Cardiovascular
Diagnostic and
Procedural Coding
Irene Mueller, EdD, RHIA
June 9, 2010
10am – Noon MDT
MHA
2010
Objectives – First hour
• Heart Dx coding
• Vessel Dx coding
Objectives - 2nd hour
• Heart Procedures
– Diagnostic
– Therapeutic
• Vessel Procedures
– Diagnostic
– Therapeutic
• Cardiac Rehabilitation
• Resources
http://anatomy.med.umich.edu/radiology/xray/images/femoral_artery_occlusion.gif
Cardiac Diagnostic Coding
• VSD 745.4
• PDA 747.0
• Coarctation of the
Aorta – 747.10
• ASD – 745.5 – 745.8
• Tetralogy of Fallot
• 745.2
• Transposition of
Great Arteries
• 745.10 – 745.19
•
•
•
•
•
CAD
MI
HTN
Heart failure
Arrhythmias
Congenital  Dx Coding
• If no specific term in ICD, use more
general terms in the AI, such as
– Anomaly, Defect, Deformity, etc.
• If anomaly is specified, but no code, use
code for other specified anomaly of that
type/site OR unspecified anomaly of that
general type/site
• Add’l codes for manifestations assigned
when specific codes not available
Congenital  Dx Coding
• Codes from Chapter 14 can be reported
for a patient of ANY age
CAD
• AKA - ASHD, coronary ischemia, and coronary
ateriosclerosis (atherosclerosis)
• Code 411.1 (unstable angina, crescendo angina,
preinfarction angina, and impending MI) as PDX
ONLY when NO underlying condition
determined and NO surgical intervention
• IF a CABG or PTCA is performed, 414.0x is
coded with additional code for unstable angina
CAD coding
• IF patient does NOT have hx of CABG,
assign code 414.01
• IF patient does have a history of CABG,
then assign appropriate code from 414.00,
414.02-414.05 range
– BUT must query Dr for specific artery
• 414.06 and 414.07 are used for CAD of a
transplanted heart
Acute MI - 410
• Two factors must be known:
– Site or type of AMI (4th digit)
• transmural, subendocardial
• check EKG interpretation for specific info
– Episode of care (5th digit)
• Initial, Subsequent, Unspec
• The 4th digit of 9 (unspecified site) & 5th digit of 0
(unspec. episode of care)
– NEVER used for inpatient encounters
– Query physician for clarification
– These can be used in outpatient settings
Acute MI – Episode of Care
• 5th digit used to indicate
– initial or
– subsequent episodes of care in the 8 weeks
after the MI
– It is safe to assume a MI admission is initial IF
the hx does not mention previous MI
Chronic/Healed MI
• Chronic MI or w/duration 8+ weeks - 414.8
• MI documented as old/healed - the coder
must determine if this is still being tx or
affecting care
• 412 is NOT assigned when current CAD is
present
• 412 is only assigned if it has an impact on
the current care
MI Example
• Pt admitted to Hospital A on 3/3 with severe chest pain, dx
as an anterolateral wall AMI (no hx of earlier care) 410.01
• Pt was transferred to University hospital later on 3/3 for
angioplasty 410.01
• Retransferred to Community Hospital on 3/6 to continue
recovery. Pt discharged on 3/8. 410.01
• Same pt readmitted to Community Hospital on 3/12 because
he was having severe chest pains. Extension of the
infarction was suspected but R/O 410.02
CAD/AMI Sequencing
• Patient adm. for angina due to CAD
– CAD is sequenced 1st w/ add’l code for angina
• Patient adm. w/unstable angina and CAD and AMI after
admission,
– AMI is sequenced 1st w/ CAD as an additional code
– Unstable angina not assigned, since progressed to AMI
• Patient adm. w/AMI and CAD; AMI code 1st w/ code for CAD
• Pt adm. w/impending MI and CH, AMI after admission
– AMI is sequenced 1st w/ appropriate codes for the CHF
• Note: NO 411 assigned w/code from 410 UNLESS
documented postmyocardial infarction syndrome,
postinfarction angina, or Dressler's syndrome
Heart Failure
• Diastolic vs Systolic
• Knowing systolic vs diastolic dysfunction is
essential
– long-term treatments are different
– MS-DRG impact
Systolic heart failure (428.2x)
• More common
– dilation of left ventricle
– with impaired contraction of heart muscle
– decreased outflow of blood from the heart
• Heart contracts w/less force
– Can’t pump our as much blood as normal
– More blood remains in lower chambers and
accumulates in veins
• CAD is a common cause
Diastolic heart failure (428.3x)
• Normal left ventricle with impaired ability to
relax muscles between contractions
– heart is stiff and doesn’t relax normally
– results in the inability to receive, as well as
eject, blood.
– As in systolic dysfunction, the blood returning
to the heart then accumulates in the veins
• Often, both forms occur together (428.4x)
5th digits for 428.2-428.4
•
•
•
•
•
0 unspecified
1 acute
2 chronic
3 acute on chronic
Acute on chronic = patient w/chronic heart
failure now has superimposed acute flareup.
• Assign 5th digit based on documentation
HEART FAILURE
• All codes for heart
failure include
– Dyspnea, orthopnea,
bronchospasm, acute
pulmonary edema
• Right Heart Failure –
usually follows leftsided heart failure; is
congestive heart
failure (includes leftsided heart failure)
– 428.0
Compensated (near-normal)
and Decompensated Heart
Failure
• Heart muscle compensation mechanisms
include
–
–
–
–
cardiac hypertrophy
raised arterial pressure
ventricular dilation
increased contraction force
• Code assignment is NOT affected by these
terms
Cardiomyopathy
• Dilated heart, flabby heart muscles, normal
coronary arteries
• Types include
– Alcohol 425.5
– Congestive, constrictive, hypertrophic, obstructive
425.4
• In most cases tx focuses on mgt of CHF and in those
instances the heart failure, 428.0 or 428.1, is the
principal diagnosis, with cardiomyopathy, 425.4,
assigned as add’l dx
• Dual coding is required for cardiomyopathy due to other
conditions, such as amyloidosis or HTN
Heart Failure Examples
• Left heart failure with B9 HTN 428.1, 401.1
• Acute CHF due to HTN 402.91, 428.0
• CHF due to hypertensive heard disease
– 402.91, 428.0
• Acute pulmonary edema with L ventricular
failure 428.1
427.5 Cardiac Arrest
• This code is PDx ONLY when the underlying
cause CANNOT be determined
– ex: pt is in cardiac arrest when arriving at hospital
and cannot be resuscitated
• Can be add’l dx when cardiac arrest occurs
during admission and the pt is resuscitated or
resuscitation is attempted
• 997.1 - Cardiac arrest as a complication of
surgery
• DO NOT use these codes to indicate pt death
HTN code categories
• ICD-9-CM has 5 HTN categories to identify type
–
–
–
–
–
401 Essential hypertension
402 Hypertensive heart disease
403 Hypertensive renal disease
404 Hypertensive heart and renal disease
405 Secondary hypertension
• 401-404 show progression of disease progress
from vascular origin to end organs involved
HTN
• ICD-9-CM classifies HTN
– by type (primary/secondary) and
– nature (B9, malignant, unspecified)
• Hypertension described as controlled or history
of HTN usually refers to an existing HTN, if it is
still under tx, then code the HTN
• due to HTN (direct causal relationship) or
hypertensive (implied relationship) indicate that
the HTN has caused other problems
– Many combination codes
B9 or Unspecified HTN
• Unspecified or Hypertension, NOS is coded to
401.9
• The coder should NEVER assume that
hypertension is malignant or benign without
physician documentation
•
• "Benign" must be stated by the physician along
with hypertension to code 401.1
HTN Table
• In AI, under main term – Hypertension
• Subterms listed in 1st column
– use same AI conventions
• With, due to, hypertensive, etc.
• 2nd – 4th columns
– Malignant, B9, and unspecified
– Dr must document for coder to use Mal/B9
• Codes MUST be verified in TL
Hypertensive  Disease
• Includes cardiomegaly, cardiovascular disease,
myocarditis, degeneration of the myocardium, and
heart failure
• When the dx statement mentions both HTN AND
heart condition, but does NOT indicate a causal
relationship, separate codes are assigned
• 402 is a combination code for hypertensive heart
diseases (5th digit indicates presence of heart
failure), add’l code needed to specify type of heart
failure
HTN and Renal Disease
• Dx statement has HTN AND renal disease
– ICD usually ASSUMES a cause/effect
relationship (403)
– 5th digit indicates presence of renal failure
– 403 does NOT include ACUTE renal failure
•
•
•
•
5th digits
0 - with CKD stage I - stage IV, or unspecified
1 - with CKD stage V or end stage renal disease
Appropriate 585 code is add’l code to id stage of
kidney disease
Hypertensive
Heart AND Renal Disease
• 402 condition AND 403 condition exist
– 404 combination code is assigned
– 5th digit indicates if CHF, renal failure, or both
are present
404
th
5
digits
• 0 – w/o heart failure & with chronic kidney disease
(CKD) stage I - stage IV, or unspec.
• 1 – w/heart failure, with CKD stage I - stage IV, or
unspecified
• 2 - w/o heart failure, with CKD stage V or ESRD
(ESKD)
• 3 - w/heart failure and with CKD stage V or ESRD
• Appropriate 585 code is add’l code to id stage of
kidney disease
HTN, DM, and CKD
• When dx indicates that both HTN AND DM
are cause of CKD, use two codes
– appropriate code from 403 OR 404 and
– 250.4x
– Add’l code for the stage of CKD
HTN w/other conditions
• Although HTN may occur with other
conditions and accelerate their
development, ICD does not have
combination codes for these
– Need multiple coding
EBP vs HTN
• 796.2 - Elevated blood pressure w/o
specificity, NOT code from 401
– Must be documented by Dr, not just recorded
• Blood pressure readings vary, tend to
increase with age (white coat HTN)
• HTN dx must be based on a SERIES of
readings
HTN Coding Examples
• CHF due to HTN
402.91, 428.0
• CHF with HTN
428.0, 401.9
• HTN, chronic kidney disease 403.91
Arrhythmias
• Main Terms
– Arrhythmia
– Block
– Dysrhyrhmia
– Specific terms (Bigeminy, etc)
• 426. - Conduction Disorders
• 427. – Cardiac Dysrhythmias
Vessel Dx Coding
• AV Malformations
• Arteriosclerosis
• Emboli
• Phlebitis
AV Malformation
• Malformation (congenital) – see also
Anomaly
• Anomaly
– Arteriovenous
• sites
Arterio/Athero-sclerosis
of Extremities
• Coder needs to determine
– 1) if native arteries or graft involved,
– 2) if progression of disease includes
•
•
•
•
A) claudication
B) rest pain
C) ulceration, or
4) gangrene
• Usually affects legs, but can be in arms
Progression of arteriosclerosis
(PAD) (PVD)
• Intermittent claudication
(from Latin for “limping”)
• A) pain when walking
– As worsens, length of
walk before pain gets
shorter, rest stops pain
• B) rest pain
– Sitting down, resting no
longer gets pain to stop
• C) ulceration, or
• 4) gangrene
• When coding, each
stage includes the
previous one
• Ex: “claudication with
ulcers”
– Code only 440.23
Thrombosis and Thrombophlebitis
of Extremities
• Thrombosis = clot has formed
Thrombophlebitis = clot is inflamed
(swelling, redness, pain)
• Atheroembolism = cholesterol crystals
from atheromatous plaques from vessels
such as the aorta or renal artery
Emboli
• Embolism = Main Term
– Type (OB, air, fat, etc.)
– Location (body part)
– Cause (due to, following, postop)
VTE (2010 Code Changes)
• Venous Thrombosis and Embolism
– Occurs in extremities, thorax, neck
•
•
•
•
•
Acute = New, initial anticoagulation tx
Chronic = Old, continuation of est. tx
Deep= DVT
Superficial
Physician documentation of venous
thrombosis is coded as acute if not further
specified
VTE
• 453.40-42
(Rev)“Acute”
– Deep, Lower
extremities
• 453.50-52 (New)
– Chronic, Lower
Extremities
• 453.6 (New)
– Superficial, Lower ext.
• 453.71-79 (New)
– Chronic, Upper
• 453.81-89 (New)
– Acute, Upper Extremities
– Antecubital, basilic, cephalic,
brachial, radial, ulnar,
axillary, subclavian, internal
jugular, etc.
• NOT same as V12.51
personal hx of
• V58.61
– Long-term (current) use of
anti-coagulants
– Add’l code, if applicable with
these codes
416.2 Chronic Pulmonary Embolism
• Small blood clots travel to the lungs
repeatedly over a period of years
• Symptoms build up gradually, including
• SOB
• leg swelling, and
• general weakness
• V58.61 is used with this code if applicable
Coding Examples
• Thrombophlebitis, femoral vein, L leg
451.11
• Arteriosclerotic ulcer and gangrene of lower
leg 440.24
Break Time
Diagnostic  Procedures
•
•
•
•
•
•
•
•
EKG (ECG), Holter monitor
Stress test (Treadmill)
Thallium or cardiolite scan
CT scan
Echocardiography
Stress echocardiogram
Angiograms
ACC/AHA Guidelines for Stable Angina
EKG (ECG)
• ICD – 89.52
• CPT –
• 93000 -- Electrocardiogram, routine ECG with
at least 12 leads; with interpretation and
report
• 93005 -- ... tracing only, without interpretation
and report
• 93010 -- ... interpretation and report only.
Holter
• Invented by Dr. Norman Holter
– Worn from 1 – 3 days
– During normal activities
• http://www.actionecho.com/videos/holtermonitor
• 89.50
• 93224-93233 (wearable ecg rhythm
derived monitoring)
Stress Tests
• Exercise (Treadmill)
– Affect on ST segment on EKG
• Pharmaceutical
– Basal Dilators
– Perfusion defect
• Thallium scan after exercise
• 89.41-89.44
Stress Test Coding - CPT
• Stress tests have three components:
– 93017 Technical (tracing only)
– 93018 Interpretation and report (Dr. service)
– 93016 Supervision (physician service)
• 93015 = global service
– includes all services above
– used when the same entity provides all parts
of the service
CT Scan
• A series of detailed pictures of areas
inside the body taken from different angles
• Created by a computer linked to an x-ray
machine
• AKA - CAT scan, computed tomography
scan, computerized axial tomography
scan, and computerized tomography
• http://www.youtube.com/watch?v=ROQlHtjSuaU
CPT coding for CT Scan
• Medicare Reimbursement for Cardiac Computed
Tomography and Computed Tomographic
Angiography. GE Healthcare. January 2009.
– http://www.gehealthcare.com/usen/community
/reimbursement/docs/CT_CTA10_2009.pdf
Echocardiography
• Transthoracic (TTE)
–
–
–
–
88.72,
93306
93307
93308
• http://www.bing.com/videos/wa
tch/video/echocardiogram/1f9e
c507a1d6ecc805271f9ec507a
1d6ecc80527-63654921571
• Transesophageal
(TEE)
– 88.72, 89.68
– 99312-99318
• http://www.actionecho
.com/videos/transeso
phageal-echo
Stress echo
• Dobutamine Stress Echocardiogram
(dobutamine echo, pharmacological
echocardiogram)
– Makes your heart “think” it is exercising
• Exercise stress echo test involves exercising on
a treadmill or stationary cycle while being
monitored
• http://actionecho.com/videos/stress-echo
Coding Stress Echos
• Outpt and Inpt
• New Echocardiography Codes and Descriptions
for 2009. American Society of
Echocardiography Coding and Reimbursement
Newsletter , January 2009.
– http://www.asecho.org/files/public/Codingnew
sJan09.pdf
Therapeutic  Procedures
• Revascularization Percutaneous
Intervention (PCI)
– Angioplasty w/wo
stenting (PTCA)
• single vessel, focal
lesion, location
– CABG
• three vessel
• Stable Angina
• Arrhythmias
– Cardioversion – 99.61,
99.62
– Ablation -37.34
– Pacemaker – some outpt,
some inpt 00.5x, 37.6-8
– Implantable cardioverter
defibrillator
• Cardiac resynchronization
device – 00.5x
– Noninvasive programmed
electrical stimulation [NIPS] 37.20
PTCA
• Coronary angioplasty - dilation of a blocked artery
with a balloon
• 00.66 – PTCA
• 00.40-00.43 – identifies the number of vessels
treated
• 00.44 –vessel bifurcation, if performed (only report
one time regardless of # vessel bifurcations treated)
• 36.04 –infusion of platelet inhibitor or other
intracoronary artery thrombolytic agent, if performed
• 99.10 –infusion of thrombolytic agent such as tissue
plasminogen activator (TPA, if performed)
Coronary Stenting
• May also be performed with PTCA
• Once vessel dilated using balloon, physician
inserts a stent to prevent re-closure
• 36.06 or 36.07 – insertion of stent
• 36.06 is reported for non-drug-eluting stents
• 36.07 is reported for drug-eluting stents
• Note: drug coated (i.e., heparin coated) stents are
reported with code 36.06
• 00.45-00.48 – number of stents
CABG
• 36.11-36.14 – identify the number of aortocoronary
bypass grafts
• AND/OR 36.15-36.16 – identify the number of internal
mammary-coronary artery bypass grafts
• AND/OR · 36.17 – use when an abdominal-coronary
artery bypass is performed (i.e., gastric artery)
• AND/OR · 36.19 – use when coronary artery bypass is
performed with vessels other than coronary, internal
mammary, or abdominal.
AND (if performed)
• 39.61 – extracorporeal circulation (i.e., cardiopulmonary
bypass)
• 00.16 – pressurized treatment of venous bypass graft
with pharmaceutical substance
Stable Angina
•
•
•
•
•
A – aspirin and anti-anginals
B – Beta-blockers and > 130/90 BP
C – low Cholesterol and no Cigarettes
D – Diet (low lipid) and Diabetes
E – Exercise and Education
• ACC/AHA Guidelines (2003)
Arrhythmia Tx
• Arrhythmias
– Cardioversion – 99.61, 99.62
– Ablation -37.34
– Pacemaker – some outpt, some inpt 00.5x,
37.6-8
– Implantable cardioverter defibrillator
• Cardiac resynchronization device – 00.5x
– Noninvasive programmed electrical stimulation [NIPS]
- 37.20
Cardioversion
• Can be done using
– energy shock (electric cardioversion)
• Device placed internally or externally
• External – emergency – defibrillator 92960
• Internal – chronic – implanted defibrillator 92961
– medications (pharmacologic cardioversion)
• Oral or IV
• Inpt or Outpt
• used to slow or terminate tachycardia
Cardiac massage
• Intermittent compression of the heart
– Pressure applied over the sternum (closed
cardiac m.)
– Directly to the heart through an opening in the
chest wall (open cardiac m.)
– Used in cardiac arrest or Vfib
• Carotid sinus massage
– Firm rotatory pressure applied to one side of
the neck over the carotid
– Used to slow or stop tachycardia
CPR
• Cardiopulmonary resuscitation (CPR) is a
combination of rescue breathing and chest
compressions
– victims thought to be in cardiac arrest
• 92950
Electrophysiology (EP)
• Cardiac specialty
• Concerned with mechanism, spread, and
interpretation of electric currents arising
within heart muscle tissue and initiating
each heart contraction
Electrophysiology (EP)
• Assesses cardiac arrhythmias, by
–
–
–
–
(1) measuring cardiac electrical activation/conduction
(2) assessing electrical activation patterns (mapping)
(3) inducing/terminating arrhythmias (with PES)
(4) assessing risk for malignant arrhythmias and sudden
cardiac death
– (5) treating with ablation, and
– (6) assessing the effects of drug and electric interventions,
including device and ablative therapies
• The approach can be either invasive or noninvasive
EP procedures
• Insertion sites commonly include the
femoral, jugular, and, occasionally,
subclavian and cephalic veins
• If necessary, femoral arteries used to gain
access to the left side of heart and for
continuous direct blood pressure
monitoring
Radiofrequency Ablation
• Nonsurgical procedure to tx some types of rapid
heart beats, usu. supraventricular tachyarrhythmias
• Physician guides catheter with electrode at tip to
muscle with accessory (extra) pathway
• Guided with real-time, moving X-rays (fluoroscopy)
• Mild, painless radiofrequency energy (similar to
microwave) is transmitted to extra pathway,
destroying carefully selected heart muscle cells in a
very small area (about 1/5 inch)
• 93650-93652
Cardiac Pacemakers and Pacing
Cardio-fibrillators (PCDs)
• Similarities
– Can be temporary/permanent
• Pulse generators implanted internally OR attached
externally
– Single chamber or dual chamber
• 1 lead in R heart (ventricle OR atrium)
• 2 leads in R heart (ventricle AND atrium)
– Surgical approach for lead(s) placement
• Epicardial –sternotomy/thoracotomy
• Endocardial - transvenous
Permanent Pacemaker
Implantation
• Recommended to
correct some types of
bradycardia heart
blocks, afib
• A pulse generator is
implanted under the
skin in the upper
chest or abdomen
and lead wires are
also attached
http://www.nlm.nih.gov/medlineplus/ency/images/ency/fulls
ize/19566.jpg
Implantable Cardioverter
Defibrillator (ICD)
• Small device implanted into
the upper chest area
– accurately analyze and tx
cardiac arrhythmias
(ventricular)
– ICD monitor senses abnormal
rhythm
– sends one + electrical
impulses or shocks to heart,
restoring normal rhythm
– Painful!
• Components
– Pulse generator, leads,
– Pacing, shocks
http://cardiophile.org/wp-content/uploads/2008/11/icd.jpg
Info Needed to Code
Pacemaker/PCD
• Single or Dual Chamber
• Epicardial or Endocardial
• Insertion
– Initial, repair, replacement, upgrade
• Entire system or just a component (lead)
• Use of fluoroscopic guidance
NIPS
• Non-Invasive Program Stimulation
• brief procedure to adjust ICD
– heart is stimulated into a rapid heart rate
– ICD delivers a shock or rapid pacing
sequence to restore a normal rhythm
– Physician can then adjust the ICD's
programming, if needed
– Pt is under anesthesia for the testing and able
to go home a few hours later
• 37.20
• 93642 Defibrillator, heart – Main Term
Diagnostic Vessel Procedures
• Diagnostic angiography (arteriography) – 88.4x
– http://www.bing.com/videos/watch/video/cardiacangiography/b2016523d08df80285dbb2016523d08df80285
db-107172005295
• Doppler studies (Dopplergram, Ultrasonography) –
88.7x
– http://video.google.com/videoplay?docid=515934433515913
8308# (Normal)
– http://video.google.com/videoplay?docid=515934433515913
8308#docid=-3954813272712307293 (PAD)
CPT Coding of Vessel
Procedures
• Selection of correct code for many
procedures requires understanding of
• Appendix L – Vascular Families
• Congenital anomalies can affect order
• See resources
Vessel Proc Coding
• endovascular Embolectomy and
thrombectomy - 38.0x
– w/endarterectomy – use Endarterectomy – 38.1x
– "Code also”
• any thrombolytic agents injected
• adjunct codes for the number of vessels treated (or if
bifurcation)
Vessel Proc Coding
• Percutaneous transluminal (balloon)
angioplasty, peripheral artery – 39.50, 00.6x
• Percutaneous transluminal atherectomy,
peripheral artery – 39.50
– http://video.about.com/heartdisease/Atherectomy
.htm
• Transcatheter stenting, percutaneous
(peripheral) (non-coronary vessel – 39.90 or
00.55
Cardiac Rehab
• Medically supervised
program
– helps improve health and
well-being
• Includes
– exercise training
• EKG monitoring
– education on heart healthy
living
– counseling to reduce stress
• Long-term commitment
from pt and team of
health care providers
–
–
–
–
–
doctors, nurses
exercise specialists
PTs and OTs
dietitians or nutritionists
psychologists or other
mental health specialists
Cardiac Rehab
• CMS Indicators (as of 1/1/2010) MC, Part B
• Statutory benefit (2008) (OIG focus)
– AMI within preceding 12 months
– CABG
– Current stable angina pectoris
– Heart valve repair or replacement
– PTCA or coronary stenting
– A heart or heart-lung transplant or,
– Other cardiac conditions as specified in a NCD
(CR only)
CMS Requirements
• 1) physician-prescribed exercise each day that
items and services are furnished
• 2) cardiac risk factor modification
• 3) psychosocial assessment
• 4) outcomes assessment and
• 5) an individualized treatment plan detailing how
components are utilized
• Individualized treatment plan must be
established, reviewed and signed by a physician
every 30 days
CMS Requirements
• Physician immediately available and accessible
for medical consultations and emergencies at all
times
• Non-physician practitioners such as nurse
practitioners or physician assistants cannot
provide direct supervision
• These requirements common problem
– OIG focus
CMS Requirements
• Medical director, as well as physicians
acting as the supervising physician, must
possess all of the following:
– (1) expertise in the management of
individuals with cardiac pathophysiology,
– (2) cardiopulmonary training in basic life
support or advanced cardiac life support, and
– (3) licensed to practice medicine in the state
CMS Cardiac Rehab
• CR sessions are limited to a maximum of
2 1-hour sessions per day
• Up to 36 sessions furnished over a period
of up to 36 weeks
• Option for an additional 36 sessions at MC
contractor discretion over an extended
period of time
42 CFR 410.49
• Items and services must be furnished in
physician’s office or hospital outpatient
setting
• All settings must have physician
immediately available and accessible for
medical consultations and emergencies at
all time items and services are being
furnished
CMS Time Requirements
• Hospitals and practitioners may report a
maximum of 2 1-hour sessions per day
• A 1-hour treatment must be at least 31
minutes
• 2 sessions = at least 91 minutes
• If several shorter periods in a given day,
the minutes of service during those
periods must be added together for
reporting in 1-hour session increments
Coding Cardiac Rehab
• V57.89 + code(s) for reason receiving
• 93797 - Physician services for outpatient cardiac
rehabilitation; without continuous ECG
monitoring (per session) and
93798 - Physician services for outpatient cardiac
rehabilitation; with continuous ECG monitoring
(per session)
Billing Cardiac Rehab
•
•
•
•
•
CR without continuous monitoring 93797
CR with continuous monitoring 93798
ICR with exercise G0422
ICR without exercise G0423
Revenue code 943 on outpatient claim
using bill types 13X for OPPS and 85X for
reasonable cost
• CAH – same codes used with revenue
codes 096X, 097X, or 098X when billed as
Method II
From First
CV
Workshop
What is clubbing?
• Prolonged lung or cyanotic heart disease can
change other parts of the body, including finger
clubbing
– Lung Cancer, CHF, emphysema, smoking,
– Tetralogy of Fallot
• ID by Hippocrates over 2,000 years ago
• AKA – drumstick fingers, Hippocratic fingers,
watch-glass nail
•
http://wwwold.path.utah.edu/casepath/PM%20Cases/PMCase4/PMCase4Image7.JPG
• http://www.clinicalexams.co.uk/images/finger-clubbing.gif
1st session Homework
• Case – ID What to code?
• Case – ID What to code?
Homework for next session
• Code Identified narrative statements from
two case studies
ILEMten@gmail.com
General Coding Resources
• Green, M. A. 3-2-1 Code It! 2nd ed. Delmar. 2010.
• ICD-9-CM Official Guidelines for Coding and Reporting,
October 1, 2009
– http://www.cdc.gov/nchs/data/icd9/icdguide09.pdf
• Maxim HI Services. Coding Corner Newsletter.
– http://www.maximhealthinformationservices.com/blog.aspx
• Moisio M. A. & E. W. Moisio, Understanding Laboratory
and Diagnostic Tests, Delmar, 1998 (2nd ed? Later)
“Clubbing” Resources
•
MedlinePlus. Clubbing of fingers or toes.
–
•
http://www.nlm.nih.gov/medlineplus/ency/article/003282.htm
Merck Manuals Online Medical Library; Home edition for Patients and Caregivers.
Symptoms and Diagnosis of Lung Disorders
–
http://www.merck.com/mmhe/sec04/ch039/ch039b.html
Cardiac Coding Resources
• Cardioversion. Doctor-reviewed article from RightHealth and
A.D.A.M.
–
http://www.righthealth.com/topic/Cardioversion/overview/adam20?fdid=Adamv2_007110&section=Full_Article
• Diagnosing Heart Disease With Cardiac Computed
Tomography (CT). 2009.
– http://www.webmd.com/heart-disease/guide/ct-heart-scan
• Doppler Echo Coding Gets a Facelift for 2009. Cardiology
Coding Alert 2008: V12, No. 2
– http://www.codinginstitute.com/articles/doppler_echo_coding_gets_a_facelift.html
• MC Reimbursement for Cardiac CT and Computed
Tomographic Angiography. GE Healthcare. January 2009.
–
http://www.gehealthcare.com/usen/community/reimbursement/docs/CT_CTA10_2009.pdf
• Stress Test Coding. Codapedia.
– http://codapedia.com/-article_233_.cfm
Cardiac Rehab Resources
• American Heart Assoc. Cardiac Rehabilitation.
– http://www.americanheart.org/presenter.jhtml?identifier=4490
• CMS Manual System. Pub 100-04, Transmittal 1974 Date:
May 21, 2010 Change Request 6850. SUBJECT: Cardiac
Rehabilitation and Intensive Cardiac Rehabilitation
– http://www.cms.gov/transmittals/downloads/R1974CP.pdf
• Heart healthy living. Cardiac Rehab.
– http://www.hearthealthyonline.com/heart-disease-overview/cardiac-rehab/
• Mackaman, D. Cardiac Rehab and Intensive Cardiac
Rehab revisited. 2010.
–
http://blogs.hcpro.com/medicarefind/2010/05/cardiac-rehab-and-intensive-cardiac-rehab-revisited/
• NHLBI (NIH). What Is Cardiac Rehabilitation?
– http://www.nhlbi.nih.gov/health/dci/Diseases/rehab/rehab_whatis.html
CAD Coding Resources
• Schnitzer, G. How to code coronary artery disease
(CAD): 414.00 vs 414.01. 2007.
– http://www.coderyte.com/Coding-corner/how-to-code-coronaryartery-disease-cad-41400-vs-41401.html
• Types of Atherectomy. About.com Heart Disease.
– http://video.about.com/heartdisease/Atherectomy.htm
EP Resources
• Programmed Electrical Stimulation. eMedicine. 2008.
– http://emedicine.medscape.com/article/163503-overview
• Radiofrequency Ablation. American Heart Association.
– http://www.americanheart.org/presenter.jhtml?identifier=4682
• Cardiac Rhythm Management and Electrophysiology ICD-9CM and CPT® Codes. February 2010.
– http://www.bostonscientific.com/cardiac-rhythmresources/assets/downloads/reimbursement/2010/CRM-EP-ICD9-CPT-Codes.pdf
• Cardiac Rhythm Resource Center. Boston Scientific.
– Webcast for Ces – no charge.
– http://www.bostonscientific.com/cardiac-rhythmresources/reimbursement/Reimbursement-Join-GuidePoint.html?
Heart Failure Coding Resources
• Challenges for Coding Heart Failure. CCS Prep!.
Advance for HI Professionals, 2007
– http://health-information.advanceweb.com/Article/Challenges-forCoding-Heart-Failure.aspx
HTN Coding Resources
• Maccariella-Hafey, P. Coding of Hypertension warrants a
second look. 2002. CCS Prep! Advance for HI
Professionals. Vol. 12 •Issue 13 • Page 8
–
http://health-information.advanceweb.com/Article/Coding-of-Hypertension-Warrants-Second-Look-1.aspx
• Test-Takers Should Become Familiar With Hypertension
Coding Guidelines. CCS Prep. Advance for HI
Professionals. 2005
– http://health-information.advanceweb.com/Article/Test-TakersShould-Become-Familiar-With-Hypertension-CodingGuidelines.aspx
Vascular Coding Resources
•
Concentric Medical. An Introductory guide for physicians, coding
professionals and practice managers to aid in understanding coding and
reimbursement for mechanical thrombectomy, embolectomy, and related
neurology procedures.
–
http://www.concentricmedical.com/upload_images/APM0210_E_Booklet,%202009%20Physician%20Coding%20Guide.pdf
• Determining selective vs. nonselective arterial
catheter placement. 2008.
–
http://www.rtimage.com/Quick_Tips_Rules_to_Choose_By_Determining_selective_vs_nonselective_arterial_cat/content=8004J05E48B684844
07698744468A0441
• Put Your First - Second-Order Proficiency to This PV
Case Study Test. Cardiology Coding Alert. 2008, v. 11,
No. 12
– http://www.codinginstitute.com/articles/Put_Your_First_SecondOrder_Proficiency_to_This_PV_Case_Study_Test.html