15 Sept 2016

Chapter 9 :Diseases of Circulatory System

Chapter 9. Diseases of Circulatory System (I00-I99)



A. Hypertension with heart disease


Hypertension and heart disease should be coded as related even though it's not documented in the medical record as related, Assign a code from category I11 (Hypertensive heart disease) with additional code from category I50


If the provider document there is no relationship between hypertension and heart disease, then code separately (Two codes), the code sequence is based on the reason for the encounter.  


B. Hypertension with chronic kidney disease


If hypertension and chronic kidney diseases are present, assign a code from category I12 (Hypertensive chronic kidney disease) with additional code from category N18 (Stage of CKD)

If the provider document there is no relationship between hypertension and kidney disease, then code separately (Two codes), the code sequence is based on the reason for the encounter.  


C. Hypertension with heart and chronic kidney disease


If a patient is having hypertension, chronic kidney disease and heart disease, Assume the relationship and Assign combination code from category I13, with additional codes for the type of heart failure (I50) and stage of CKD (N18).


D. Hypertension, Secondary


Hypertension is due to an underlying condition. Two codes are required, one code for etiology and another code from category I15 for secondary hypertension.


E. Hypertension, controlled / uncontrolled


Uncontrolled refer to hypertension not responding to current medication.


Assign the appropriate code from categories I10-I15


F. Hypertension, Transient


If there is no established diagnosis of hypertension code only R03.0 (Elevated blood pressure).

G. Hypertension Crisis 

Assign I16 (Hypertensive crisis) for Hypertensive urgency, hypertension emergency or an unspecified hypertensive crisis. 


Atherosclerotic coronary artery disease and angina:


Combination codes for atherosclerotic heart disease with angina pectoris.


Subcategories I25.11 (Atherosclerosis heart disease of the native coronary artery with angina pectoris)


I25.7 (Atherosclerosis heart disease of coronary artery bypass graft with angina pectoris)  - Don't code angina code separately. 


A causal relationship can be assumed in a patient with both atherosclerotic coronary artery disease and angina is documented, unless it indicated the angina is due to some other reason. 

Patient with coronary artery disease admitted due to Acute Myocardial Infarct; code AMI as first Dx followed by CAD. 


Sequelae of cerebrovascular disease:


Category I69 is used to indicate conditions classifiable to categories I60-I67 as the causes of sequela. These late effects include neurologic deficits that persist after the onset of conditions classifiable to categories I60-I67


Category I69 is used along with I60-I67 if the patient has a current cerebrovascular disease and deficits from an old cerebrovascular disease.


Use appropriate history codes for H/o TIA and cerebral infarction.


Category I69 and I60-I67 may be reported together if current CVA and deficit from an old CVA are documented.

Personal History codes  (Z86.73) - Don't code category I69 if the patient doesn't have a neurologic deficit. 

Acute Myocardial Infarction (AMI):


If encounter occurring while the MI is less than four weeks old, assign from category I21


Encounter after the 4th week, appropriate aftercare should be used not the I21


For old/healed MI, assign I25.2 (old myocardial infarction)

Subsequent acute myocardial infarction


A code from category I22, to be used when a patient who has suffered an AMI has a new AMI (Type 1 or Unspecified) within the 4 week time of the initial AMI


     - For Subsequent Type 2 AMI - I21.A1

     - For Subsequent Type 4 or 5 AMI - I21.A9

Both category codes (I22 and I21) must be used together if both the initial and subsequent myocardial infarcations are type 1 or unspecified. 


Subcategories I21.0 - I21.2 and I21.3 used for STEMI


Subcategories I21.4 used for NSTEMI


Note: If NSTEMI evolves to STEMI – code the STEMI 


If STEMI converts to NSTEMI due to thrombolytic therapy – code as STEMI



Test your knowledge:

                A. Chapter 9 & 10 ICD 10 CM Quiz