Preparing for ICD-10
for Hospitals
May 2011
Copyright 2011 Medtronic
Notices
These coding suggestions and coverage guidelines do not
replace seeking coding advice from the payer and/or your
coding staff. The ultimate responsibility for correct coding lies
with the provider of services. Please contact your local payer for
interpretation of the appropriate codes to use for specific
procedures. Medtronic makes no guarantee that the use of this
information will prevent differences of opinion or disputes with
Medicare or other third party payers as to the correct form of
billing or the amount that will be paid to providers of service.
See NCD 20.8 for Medicare covered indications for pacemakers
and NCD 20.4 for Medicare covered indications for defibrillators.
Copyright 2011 Medtronic
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CEUs for Coders
A survey will be sent out to all registered participants a few days
after the session. The CEU certificates will be included in the
survey as attachments for those who listened to the entire session.
AAPC
This program has the prior approval of the American Academy of
Professional Coders (AAPC) for 2 continuing education hours.
Granting of prior approval in no way constitutes endorsement by
AAPC of the program content or the program sponsor.
AAPC Index# MTI0329110337A.
AHIMA
This program has been approved for 2 continuing education units
for use in fulfilling the continuing education requirements of the
American Health Information Management Association (AHIMA).
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Topics
Preparing for ICD-10
An Introduction to ICD-10 for Cardiovascular

Background

ICD-10-CM Diagnosis Codes

ICD-10-PCS Procedure Codes

DRGs under ICD-10

Appendix
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Background
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Components of ICD-10
ICD-10 has two main components:
 ICD-10-CM is for diagnosis codes and includes a tabular
list, an index, and tables for drugs and neoplasms.
 ICD-10-PCS is for procedure codes and includes code
tables and an index.
There are other materials that are also officially part of the
classification system, including:
 GEMs
 Body Part Key
 Device Key
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 Official Guidelines for Coding
and Reporting
 ICD-10-PCS Reference Manual
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This Is Going to Happen
 ICD-10 was adopted as the national standard under HIPAA
(Federal Register, January 16, 2009, pp.3328-3362)
and its use is mandatory
 The effective date for implementation is October 1, 2013
 Which components of ICD-10 must be used depends on
the type of provider:
Provider
Setting
Diagnoses
Procedures
Hospitals
Inpatient
ICD-10-CM
ICD-10-PCS
Hospitals
Outpatient
ICD-10-CM
CPT®
ASCs
Outpatient
ICD-10-CM
CPT®
Physicians
Facility/Office
ICD-10-CM
CPT®
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ICD-10 Freeze
Starting October 1, 2011, all codes in
ICD-10 will be frozen for 3 years.
The ICD-10 Coordination and Maintenance
Committee announced the freeze to allow a
period of stability for programming, publishing,
and training for implementation of ICD-10.
 Limited updates may take place on October 1, 2012 and
October 1, 2013 for new technologies and new diseases
 The deadline for submitting change requests prior to the
freeze has already passed
 The C&M Committee will continue to meet during the freeze
 Regular annual updates will resume on October 1, 2014
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GEMS
The General Equivalence
Mappings are a very useful tool
for translating between ICD-9-CM
and ICD-10.
 The “forward” GEM converts
current ICD-9-CM codes to
their equivalent ICD-10 codes
 The “backward” GEM converts ICD-10
codes back to ICD-9-CM codes
While very handy, GEMS are not a substitute for learning
ICD-10. They’re intended for use in converting large
databases, not for coding individual cases.
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Limits of GEMS
Particularly for procedure codes,
many ICD-9-CM codes convert to
far more than one ICD-10 code.
ICD-9-CM ICD-10-PCS
3795
02H63ME
3795
02H73ME
Example: 37.95, implantation of ICD lead(s)
3795
02HK3ME
3795
02HL3ME
There are other limits in GEMs conversion
of ICD-9-CM codes to ICD-10:
3795
02HN0ME
3795
02HN4ME
 Some conversions are theoretically possible but unlikely
 Some codes convert to a “cluster” rather than one-for-one
 Some codes don’t convert directly to ICD-10 at all
In making the transition to ICD-10, the best way to use the
GEMs is either as a starting place or for confirmation.
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ICD-10-CM
Diagnosis Codes
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Format of ICD-10-CM Diagnosis Codes
The format of ICD-10-CM has several new features:
 Codes can be from 3 to 7 characters long
 The first digit is always a letter (only “U” is not used)
 The second and third digits are always numbers
 The fourth to seventh digits can be letters or numbers
 A decimal is placed after the third digit
Examples
I11.0
Hypertensive heart disease with heart failure
R55
Syncope
T82.120A
Displacement of cardiac electrode, initial encounter
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Greater Specificity
ICD-10-CM has far more diagnosis codes than ICD-9-CM.
System
# Diagnosis Codes
ICD-9-CM
14,025
ICD-10-CM
68,069
The majority of new codes involve:
 Greater specificity for injuries, including site, type, and
encounter
 Laterality (left, right, bilateral)
 Specificity for device complications, including encounter
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Heart Block
The heart block codes in ICD-10-CM are quite similar to
those in ICD-9-CM.
 Complete heart
block retains a
distinct code,
which remains a CC
 ICD-10-CM doesn’t
make a distinction
between Mobitz and
other second degree
blocks
Copyright 2011 Medtronic
I44 Atrioventricular and left bundle-branch block
I44.0 Atrioventricular block, first degree
I44.1 Atrioventricular block, second degree
Atrioventricular block, type I and II
Mobitz block, type I and II
Second degree block, type I and II
Wenckebach's block
I44.2 Atrioventricular block, complete
Complete heart block NOS
Third degree block
………………………………………
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Other Conduction Disorders
Other codes for pacemaker and defibrillator indications
related to conduction are located in I45.
 Codes for bifascicular
and trifascicular
blocks were actually
simplified; the codes
reflect pacemaker
indications and also
remain CCs
I45 Other conduction disorders
 Long QT syndrome
retains a distinct code,
as needed to reflect the
defibrillator indication
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I45.2 Bifascicular block
I45.3 Trifascicular block
I45.6 Pre-excitation syndrome
Lown-Ganong-Levine syndrome
Wolff-Parkinson-White syndrome
………………………………………
I45.8 Other specified conduction disorders
I45.81
Long QT syndrome
I45.89
Other specified conduction disorders
Atrioventricular dissociation
Interference dissociation
Nonparoxysmal AV nodal tachycardia
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Paroxysmal Tachycardia
 VT is an indication
for defibrillators and
remains a CC
 Re-entry ventricular
arrhythmia has its
own code
I47 Paroxysmal tachycardia
I47.0 Re-entry ventricular arrhythmia
I47.1 Supraventricular tachycardia
Atrial paroxysmal tachycardia
Atrioventricular paroxysmal tachycardia
Junctional paroxysmal tachycardia
Nodal paroxysmal tachycardia
I47.2 Ventricular tachycardia
 Note that I47.0 and
I47.9
I47.1 are not assigned
for AVNRT (atrioventricular
nodal reentrant tachycardia)
Paroxysmal tachycardia unspecified
Note: As in ICD-9-CM, tachycardia not otherwise specified
is assigned to a symptom code.
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Atrial Fibrillation and Flutter
Like ICD-9-CM, the current version
of ICD-10-CM has just two codes
for atrial fibrillation and flutter.
I48 Atrial fibrillation and flutter
I48.0 Atrial fibrillation
I48.1 Atrial flutter
However, it is likely that this will be expanded on October 1,
2011 to capture more detail.
WHO is updating the international version of ICD-10 for these
codes and the US must maintain compatibility. A proposal
was recently presented before the C&M Committee to create
specific codes within I48 for atrial fibrillation documented as:
 Persistent  Permanent
 First episode  Paroxysmal
http://www.cdc.gov/nchs/icd/icd9cm_maintenance.htm
March 9-10, 2011 proposals, pages 48-50
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Other Cardiac Arrhythmias
 VF is a defibrillator
indication and
remains an MCC
 SSS retains a distinct
code, as needed to
reflect the pacemaker
indication
 The depolarization
codes are new
 According to the index,
AVNRT is assigned to
I49.8
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I49 Ventricular fibrillation and flutter
I49.0 Ventricular fibrillation and flutter
I49.01
I49.02
Ventricular fibrillation
Ventricular flutter
I49.1 Atrial premature beats
I49.2 Junctional premature depolarization
I49.3 Ventricular premature depolarization
……………………………………
I49.5 Sick sinus syndrome
Tachycardia-bradycardia syndrome
I49.8 Other specified cardiac arrhythmias
I49.9 Cardiac arrhythmia unspecified
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Heart Failure
ICD-10-CM codes for heart failure are
essentially the same as the ICD-9-CM
codes. This is actually by intent.
The main differences are:
 ICD-10-CM has no code for “congestive heart failure”
per se; it is included in I50.9 for unspecified heart failure
 “Congestive” is a non-essential term for heart failure
 When any form of pulmonary edema (acute, chronic,
unspecified) is present with heart failure, L50.1 for left
ventricular failure is assigned
In addition to being a CC or MCC, heart failure is a major
indication for defibrillators and bi-ventricular devices.
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Heart Failure Code Structure
 CCs and
MCCs
remain
the same
 Because
it is coded
to I50.1,
pulmonary
edema is
a CC
rather
than an
MCC
I50 Heart failure
I50.1 Left ventricular failure
I50.2 Systolic (congestive) heart failure
I50.20
I50.21
I50.22
I50.23
Unspecified systolic (congestive) heart failure
Acute systolic (congestive) heart failure
Chronic systolic (congestive) heart failure
Acute on chronic systolic (congestive) heart failure
I50.3 Diastolic (congestive) heart failure
I50.30
I50.31
I50.32
I50.33
Unspecified diastolic (congestive) heart failure
Acute diastolic (congestive) heart failure
Chronic diastolic (congestive) heart failure
Acute on chronic diastolic (congestive) heart failure
I50.4 Combined systolic (congestive) and diastolic (congestive)
heart failure
I50.40
I50.41
I50.42
I50.43
Unspecified combined (congestive) heart failure
Acute combined (congestive) heart failure
Chronic combined (congestive) heart failure
Acute on chronic combined (congestive) heart failure
I50.9 Heart failure, unspecified
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Heart Failure Due to Hypertension
ICD-10-CM maintains the current coding practices for
heart failure due to hypertension.
 An additional code is
used from I50 to show
the type of heart failure
 ICD-10-CM does not
differentiate between
benign, malignant,
and unspecified
hypertensive disease
I11 Hypertensive heart disease
I11.0 Hypertensive heart disease with
heart failure
Hypertensive heart failure
Use additional code to identify type of
heart failure (I50.-)
I11.9 Hypertensive heart disease without
heart failure
ICD-10-CM has similar codes for hypertensive heart and
chronic kidney disease.
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Chest Pain
Chest pain codes are both reorganized and expanded.
 ICD-10-CM more clearly
differentiates anterior
chest wall pain from
types of respiratoryrelated pain
R07
Pain in throat and chest
R07.0 Pain in throat
R07.1 Chest pain on breathing
Painful respiration
R07.2 Precordial pain
R07.8 Other chest pain
 According to the index,
code R07.89 also
classifies chest
pressure, tightness,
and discomfort
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R07.81 Pleurodynia
R07.82 Intercostal pain
R07.89 Other chest pain
Anterior chest wall pain
R07.9 Chest pain unspecified
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Coronary Artery Disease
There are over 35 codes for CAD, reflecting different types of
vessels as well as combination codes for CAD with angina.
 Category I25.1 is for CAD of native coronary vessels
 Category I25.7 is CAD of other coronary vessels with angina
Subcategory Vessel Type
I25.70
Coronary artery bypass graft(s), unspecified type
I25.71
Coronary artery bypass graft(s), autologous vein
I25.72
Coronary artery bypass graft(s), autologous artery
I25.73
Coronary artery bypass graft(s), nonautologous biological
I25.75
Coronary artery, native, transplanted heart
I25.76
Coronary artery bypass graft(s), transplanted heart
I25.79
Coronary artery bypass graft(s), other type
 Category I25.8 is CAD of other coronary vessels without
angina
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CAD of Native Coronary Arteries
Subcategory I25.11 shows the
basic structure for the combination
codes for CAD with angina.
I25.1
Atherosclerotic heart disease of native coronary artery
Coronary artery disease
I25.10
ASHD of native coronary artery without angina pectoris
I25.11
ASHD of native coronary artery with angina pectoris
I25.110 ASHD of native coronary artery with unstable angina pectoris
I25.111 ASHD of native coronary artery with angina pectoris with
documented spasm
I25.112 ASHD of native coronary artery with other forms of angina pectoris
I25.119 ASHD of native coronary artery with unspecified angina pectoris
ICD-10-CM assumes a causal relationship between angina
and atherosclerosis.
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Acute Myocardial Infarction
The ICD-10-CM AMI codes have several key differences
from the AMI codes in ICD-9-CM.
 ICD-10-CM differentiates primarily
between anterior wall and inferior
wall, then by the coronary artery
involved
 ICD-10-CM does not differentiate by episode of care
 Rather than 8 weeks, acute MI is defined as a duration
of 4 weeks (28 days) or less from onset
 ICD-10-CM has distinct categories for the initial MI and
for subsequent re-infarction
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Subsequent Infarction
Codes in I22 are used for a repeat infarction within 4 weeks
(28 days) of a previous AMI, regardless of site.
I22 Subsequent STEMI and NSTEMI myocardial infarction
I22.0 Subsequent STEMI of anterior wall
I22.1 Subsequent STEMI of inferior wall
I22.2 Subsequent NSTEMI
I22.8 Subsequent STEMI of other sites
I22.9 Subsequent STEMI of unspecified site
 Codes in I22 are never used alone; they are always used
with a code from I21
 The I22 code is sequenced first if the repeat AMI leads to
a second admission, or after the I21 code if it occurs
during the same admission as the initial AMI
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Cardiomyopathy
Cardiomyopathy, an indication for defibrillators, has expanded
codes for greater specificity.
 Ischemic
cardiomyopathy has
its own code, distinct
from other forms of
chronic ischemic
heart disease
 Congestive, restrictive
and non-obstructive
hypertrophic
cardiomyopathy
have their own codes,
all CCs
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I25.5 Ischemic cardiomyopathy
I42 Cardiomyopathy
I42.0 Dilated cardiomyopathy
Congestive cardiomyopathy
I42.1 Obstructive hypertrophic cardiomyopathy
I42.2 Other hypertrophic cardiomyopathy
Non-obstructive
……………………………………
I42.5 Other restrictive cardiomyopathy
……………………………………
I42.8 Other cardiomyopathies
I42.9 Cardiomyopathy unspecified
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Non-Rheumatic Valve Disorders
In ICD-10-CM, each
valve has its own
code category.
 Within each category, there are
distinct codes for each specific
type of valve disorder
I35 Non-rheumatic aortic valve disorders
Category
Valve
I34
Mitral
I35.0 Non-rheumatic aortic (valve) stenosis
I35
Aortic
I36
Tricuspid
I37
Pulmonary
I35.1 Non-rheumatic aortic (valve) insufficiency
Non-rheumatic aortic (valve) incompetence
Non-rheumatic aortic (valve) regurgitation
I35.2 Non-rheumatic aortic (valve) stenosis with
insufficiency
I35.8 Other non-rheumatic aortic valve disorders
I35.9 Non-rheumatic aortic valve disorder
unspecified
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Historical Conditions
As with ICD-9-CM, historical conditions which are indications
for defibrillators are distinctly identified in ICD-10-CM.
Old Myocardial Infarction
 This has its own code in chronic ischemic heart disease
I25.2 Old myocardial infarction
History of SCD
 Family and personal history are separately identified
Z82.41
Family history of sudden cardiac death
Z86.74
Personal history of sudden cardiac arrest
Personal history of sudden cardiac death successfully resuscitated
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Attention to Cardiac Device
Like ICD-9-CM, ICD-10-CM has specific codes for use when
the encounter focuses on attention to a device rather than
the underlying condition, as in:
 Routine device replacement, eg. end-of-battery life
 Encounter for device interrogation or programming
Z45.0 Encounter for adjustment and management of cardiac device
Z45.01 Encounter for adjustment/management of cardiac pacemaker
Z45.010 Encounter for checking and testing pacemaker pulse generator
Encounter for replacing cardiac pacemaker pulse generator [battery]
Z45.018 Encounter for adj/mgt of other part of cardiac pacemaker
Z45.02 Encounter for adj/mgt of automatic implantable cardiac defibrillator
Z45.09 Encounter for adj/mgt of other cardiac device
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Device Complications
ICD-10-CM continues to classify
device complications as mechanical,
infection, and other (non-mechanical).
 Definitions are the same as ICD-9-CM for mechanical
(eg. breakdown) and other non-mechanical (eg. pain)
 Mechanical complication codes are defined as electrode
vs generator, rather than by the type of device
 The nature of the mechanical complication is more specific,
eg. breakdown, displacement or other complication
 The nature of the non-mechanical complication is also
more specific, eg. embolism, hemorrhage
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Device Complication Code Structure
T82.1 Mechanical complication of cardiac electronic device
 All codes
require a 7th
T82.11 Breakdown (mechanical) of cardiac electronic device
T82.110 Breakdown of cardiac electrode
digit for
T82.111 Breakdown of cardiac pulse generator
episode of care
T82.118 Breakdown of other cardiac electronic device
A initial
encounter
D subsequent
encounter
S sequela
T82.12 Displacement of cardiac electronic device
T82.120 Displacement of cardiac electrode
T82.121 Displacement of cardiac pulse generator
T82.128 Displacement of other cardiac electronic device
…………………………………………………
T82.7 Infection/inflammatory reaction to other cardiac devices
………………………………………………….
 All codes are
T82.8 Other specified complications of cardiac/vascular devices
CCs but only
T82.84 Pain from cardiac and vascular devices
for the initial
T82.847 Pain from cardiac devices, implants and grafts
T82.848 Pain from vascular devices, implants and grafts
episode of care
…………………………………………………..
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ICD-10-CM Coding Guidelines
Codes aren’t complete without uniform guidelines on usage.
 As with ICD-9-CM, there is a set of “ICD-10-CM Official
Guidelines for Coding and Reporting”
 Use of the Official Guidelines is mandatory under HIPAA
 The Official Guidelines are still in draft form but will be
finalized prior to October 1, 2013
 The quarterly journal Coding Clinic®
will also continue
 Coding Clinic® will begin addressing
ICD-10 guidance in advance of the 2013
implementation date
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ICD-10-PCS
Procedure Codes
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A New Concept
ICD-10-PCS is completely unlike ICD-9-CM, or any other
coding system for that matter.
Key characteristics are:
 Codes are not assigned, they
are built character-by-character
from tables of values
 Within a section, each character
represents a standard element
 All terms, particularly root operations,
have standard definitions
 There are very few defaults
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Format of ICD-10-PCS Codes
The format of ICD-10-PCS is a complete departure from
the past.
 All codes are 7 characters long, without exception
 All codes are alphanumeric (letters “I” and “O” are not used)
 There are no decimal points
Examples
027034Z
Dilation of Coronary Artery, One Site, with Drug-Eluting
Intraluminal Device, Percutaneous Approach
0JH60P5
Insertion of CRT-D Pulse Generator into Subcutaneous
Tissue/Fascia, Chest, Open Approach
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Character Counts!
In section “0”, Medical and Surgical procedures, the
character meanings are:
1
section
2
3
4
5
root operation
approach
body system
body part
6
7
qualifier
device
 Body system, eg. urinary, GI, respiratory, upper arteries




Root operation, eg. bypass, dilation, destruction
Body part, eg. left external iliac artery, duodenum, sacrum
Approach, eg. open, endoscopic via natural opening
Device, eg. infusion device, cardiac lead, tissue expander
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Coding Character by Character
027034Z
Dilation of Coronary Artery, One Site, with Drug-Eluting
Intraluminal Device, Percutaneous Approach
1
Section
0
Medical & Surgical
2
Body system
2
Heart & Great Vessels
3
Root operation
7
Dilation
4
Body part
0
Coronary Artery, One Site
5
Approach
3
Percutaneous
6
Device
4
Drug-Eluting Intraluminal Device
7
Qualifier
Z
No Qualifier
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Code Table Example: PTCA and Stent
PTCA with drug-eluting stent
027034Z
Dilation of Coronary Artery, One Site, with Drug-Eluting
Intraluminal Device, Percutaneous Approach
PTCA with non-drug-eluting (bare metal) stent
02703DZ
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Dilation of Coronary Artery, One Site, with Intraluminal
Device, Percutaneous Approach
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Insertion of CRDM Generators
Pacemaker: 0JH60P2
Defibrillator: 0JH60P4
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CRT-P (BiV): 0JH60P3
CRT-D (BiV): 0JH60P5
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Insertion of CRDM Leads
Pacemaker leads, RA and
RV, transvenous:
02H63MA, 02HK3MA
CRT-P leads, RA and RV,
transvenous:
02H63MA, 02HK3MA
Defibrillator leads, RV,
epicardial placement:
02HN0ME
CRT-D leads, RA, RV, and LV
via the CS, transvenous:
02H63ME, 02HK3ME, 02H43ME
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Codes for CRDM Systems
Unlike ICD-9-CM, ICD-10-PCS does not have codes for
implantation of an entire device system. Instead, components
are coded individually.
Implantation of dual chamber
pacemaker with transvenous
RA and RV leads
Generator
0JH60P2
RA lead
02H63MA
RV lead
02H6KMA
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Implantation of CRT-D with
transvenous RA and RV leads,
and transvenous LV lead via
the coronary sinus
Generator
RA lead
RV lead
LV (CS) lead
44
0JH60P5
02H63ME
02HK3ME
02H43ME
Replacement of Device
Root operation R-Replacement is not used to code
replacement of devices. It’s used for replacing a native
body part with a device, eg. valve replacement.
Root operation W-Revision is also not used to code
replacement of devices. It’s for correcting an existing
device, eg. repositioning a lead.
Instead, device replacement in ICD-10-PCS takes two codes:
 Insertion of the new device,  Removal of the old device,
using operation H-Insertion
using operation P-Removal
Removal codes contain less detail than Insertion codes.
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Removal of CRDM Generators
Pacemaker
Defibrillator
CRT-P (BiV)
CRT-D (BiV)
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0JPT0PZ
46
Removal of CRDM Leads
Pacemaker
Defibrillator
CRT-P (BiV)
CRT-D (BiV)
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Any chamber
or location
47
02PA3MZ
Replacement of Rhythm Devices
When a device is replaced, eg. end-of-battery life, complication,
or upgrade, Insertion and Removal codes are used together.
Replacement of defibrillator
generator due to end-of-life
Insertion of new generator
0JH60P4
Removal of old generator
0JPT0PZ
Upgrade of pacemaker to CRT-D
(replacement of generator, new LV
lead via coronary sinus, retention of
existing RA and RV leads)
Insertion of new CRT-D generator
0JH60P5
Replacement of broken CRT-D
RV lead, transvenous
Removal of old pacer generator
0JPT0PZ
Insertion of new lead
02HK3ME
Removal of old lead
02PA3MZ
Insertion of LV lead via CS
02H43ME
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Diagnostic EPS
Diagnostic EPS : 4A023FZ
 The ICD-10-PCS Reference Manual uses EPS as an
example of root operation K-Map but the example is
incomplete
 It is essential to use code 4A023FZ to
obtain correct DRG assignment for EPS
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* See the Appendix
for table 02K for
mapping and table
025 for EP ablation
Cardiac Catheterization
RHC: 4A023N6
LHC: 4A023N7
R&L HC: 4A023N8
 It’s essential to use code 4A023N~ to obtain correct
DRG assignment, particularly when the cardiac cath is
performed with other CRDM and cardiac procedures
 Additional codes are assigned from
table B20 or B21 for angiography of the
heart and coronary arteries
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* See the Appendix for
table B21 as used for
arteriography of the
heart/coronary arteries
PTCA : What is a Site?
 A “site” does not equal a single coronary artery
 Interventions at distinct sites within the same coronary
artery are coded as multiple sites, but multiple stents in
the same coronary artery may or may not be different sites
 Different interventions require separate codes
Angioplasty of two distinct sites in the LAD each with a drug-eluting
stent, LCx with a drug-eluting stent, and angioplasty of RCA without
stent: 027234Z, 02703ZZ
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Atherectomy
 In ICD-9-CM, angioplasty and atherectomy use the
same code but in ICD-10-PCS, they are separate codes
 Angioplasty is coded to root operation 7-Dilation but
atherectomy is coded to root operation C-Extirpation
 No guidelines have been published yet but presumably,
if both angioplasty and atherectomy take place within the
same vessel, both are coded
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CABG
 Device refers to grafts obtained from patients (eg. SVG) or
cadavers, or as products; no device is direct anastomosis
 The qualifier refers to the
Aorta-coronary bypass,
one site, with SVG:
origin of the bypass, ie.
021009W
source of the new blood flow
 Separate codes are assigned
RIMA-coronary artery
bypass, one site:
for each bypass that uses
02100Z8
a different device or qualifier
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Valve Replacement
 This is a true replacement for coding purposes because
the new valve physically takes over the place and the
function of the native valve
Replacement of aortic valve with porcine valve: 02RF08Z
Replacement of mitral valve with mechanical valve: 02RG0JZ
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Greater Specificity
ICD-10-PCS has far more procedure codes than ICD-9-CM.
System
# Procedure Codes
ICD-9-CM
3,824
ICD-10-PCS
72,589
The sheer volume of codes can be daunting at first but
some constructs are far less likely than others.
The structure of ICD-10-PCS has key consequences in:
 ease of expansion for new procedures and technologies
 greater depth of clinical documentation and knowledge
required to assign codes
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ICD-10-PCS Coding Guidelines
 The ICD-10-PCS Reference Manual
contains an appendix with draft
procedure coding guidelines
 Guideline use is mandatory under HIPAA
 The ICD-10-PCS Reference Manual also
contains many helpful examples
 An ICD-10-PCS Body Part Key is available to help users
choose the correct value for specific anatomic structures
 CMS is developing an ICD-10-PCS Device Key with trade
names to help users choose the correct device value
 Coding Clinic® will address procedure code issues as well
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DRGs under ICD-10
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MS-DRG Conversion
CMS’s stated objective in the MS-DRG conversion is:
“for data coded in ICD-10, the ICD-10 MS-DRGs would
assign the same MS-DRG had the same case been
(See the Appendix for the link)
coded using ICD-9-CM codes”
In other words, CMS is not taking advantage of the ICD-10
transition to make changes to MS-DRG assignments.
DRG titles and concepts
are unchanged. The
conversion is strictly about
the codes used, not about
the MS-DRG structure
itself.
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DRG Grouper Version
CMS has gone through two iterations of the MS-DRG
Grouper using ICD-10 codes:

V26 (FY 2009) was released for public comment in 2009

V28 (FY 2011) was released in February 2011 and
comments are currently being taken
Although ICD-10 codes will be final in October 2011, the
MS-DRG Grouper for ICD-10 is still in draft form.

V29 (FY 2012) is expected to be released in October 2011

The final version of the MS-DRG Grouper with ICD-10
codes is subject to the formal rule-making process
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CC/MCC Lists
In keeping with the objective of assigning the same DRGs,
all conditions that are CCs/MCCs in ICD-9-CM are also
CCs/MCCs in ICD-10-CM.
 In some cases where ICD-10-CM codes reflect combined
conditions, an automatic CC or MCC DRG is assigned
Example: I25.110 Atherosclerotic heart disease of native coronary
artery with unstable angina pectoris
 In conflicts where an ICD-10-CM code could be either a
CC or an MCC, designation was based on frequency data
 New codes were factored into the CC Exclusion List
Example: I22.~, subsequent AMI, is excluded as an MCC when
I21.~, initial AMI, is the principal diagnosis
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Qualifier Z for Lead Insertion
 Don’t default to qualifier Z!
 Pacemaker DRGs are assigned when
qualifier Z is used
 Be sure to assign qualifier A for all pacemaker and CRT-P
leads and qualifier E for all defibrillator and CRT-D leads
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Different DRGs?
Be alert to unexpected DRGs.
If the ICD-10 DRG assigned to a particular case is different
from the ICD-9-CM DRG, either the codes are incorrect or
the DRG structure is flawed.
 Check the ICD-10 codes assigned, with
attention to the value for each character
and the need for multiple codes
 Verify the DRG assignment manually
Medtronic can assist in DRG
verification and in notifying CMS
about discrepant DRG logic.
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Appendix
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Key Websites
The CDC and CMS have a wealth of educational materials
and resources available on-line, both for implementation of
ICD-10 and the MS-DRG conversion.
ICD-10-CM Diagnosis Codes
http://www.cdc.gov/nchs/icd/icd10cm.htm
draft ICD-10-CM coding guidelines
ICD-10-CM tabular and index
diagnosis code GEMS
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Key Websites
ICD-10-PCS Procedure Codes
http://www.cms.gov/ICD10/11b_2011_ICD10PCS.asp#TopOfPage
ICD-10-PCS
tables and index
ICD-10-PCS
Reference Manual
procedure code
GEMS
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Key Websites
DRGs
http://www.cms.gov/ICD10/17_ICD10_MS_DRG_Conversion_Project.
asp#TopOfPage
Hospital payment
impact analysis
MS-DRG Grouper
in ICD-10 (manual)
MS-DRG Grouper
in ICD-10 (pilot
software)
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Table 02K: Mapping
 Table 02K is used for cardiac mapping, eg. 02K83ZZ
 This does not represent a full electrophysiologic study
 For EPS plus cardiac mapping, two codes must be used:
 one from table 4A0 for the electrophysiologic study
 one from table 02K for mapping
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Table 025: Electrophysiologic Ablation
Endovascular EP ablation of
arrhythmogenic focus in LA:
02573ZZ
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Endovascular EP ablation of
atrioventricular node:
02583ZZ
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Table B21: Heart Angiography
Arteriography of native coronary
arteries with high osmolar contrast:
B2110ZZ
Left ventriculography with low
osmolar contrast:
B2150ZZ
 When performed with a cardiac catheterization, these
codes are assigned separately
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Coding Hotlines
You can contact Medtronic for assistance with coding and
reimbursement issues.
Cardiac Rhythm Disease Management
(866) 877-4102, option 1
Vascular
(877) 347-9662
Structural Heart
(866) 616-8400
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Question Time
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Thanks for Participating!
We hope this was informative.
If you have any comments or questions,
please send us an email at:
rs.healthcareeconomics@medtronic.com
Medtronic Inc.
Minneapolis, MN
www.medtronic.com
Copyright 2011 Medtronic