414.4 Lets You Get Precise About Calcified Coronary Lesions

But 425.1 will take along instant denials

Don't think that your ICD-9 2012 update lists final till you've studied these late additions for coronary atherosclerosis and hypertrophic cardiomyopathy.

Even though coders get information about ICD-9 changes each summer in CMS's suggested Inpatient PPS rule, those specific changes aren't the last word for updates. The codes below got effective Oct. 1, 2011.

414.4 Helps Identify Coronary Lesions

ICD-9 2012 adds 414.4 (Coronary atherosclerosis due to calcified coronary lesion).

The goal was to be able to differentiate a calcified lesion from other ischemic lesions. Calcified lesions are different as lipid rich plaque (414.3, Coronary atherosclerosis due to lipid rich plaque) as well as chronic total occlusions (414.2, Chronic total occlusion of coronary artery). And 414.8 (Other specified forms of chronic ischemic heart disease) is too common to identify the nature of the lesion.

Calcified lesions can be identified both by x-ray during coronary angiography along with intravascular ultrasound, and might be more challenging to treat than further coronary lesions. In case the physician is unable to cross the calcified lesion, he might have to stop the treatment and the patient may then need medical management or an extra invasive procedure.

Term tip: The code definition maintains calcified coronary lesion, however a note with the code explains that it is suitable when the physician documents coronary atherosclerosis owing to severely calcified coronary lesion.

"Severely" is a significant part of the diagnosis. However coders may not find the term "severely" in the documentation.

One more instruction with 414.4 informs you that you should code first coronary atherosclerosis (414.00-414.07). Consequently your first-listed code must specify the atherosclerosis (for instance 414.01, Coronary atherosclerosis of native coronary artery). After that report 414.4 in case the physician documents the situation is linked to a calcified coronary lesion.

425.1 Now Necessitates a 5th Digit

ICD-9 2012 offers novel coding selections for hypertrophic cardiomyopathy.

Reason: Hypertrophic cardiomyopathy can have two planes of demonstration, obstructive or nonobstructive. Whether or not it is obstructive can influence the requirement for dissimilar medical or surgical treatments.

2011: In ICD9 2011 , 425.1 was a binding code defined as "Hypertrophic obstructive cardiomyopathy." In case you required reporting nonobstructive hypertrophic cardiomyopathy, you reported 425.4 (Other primary cardiomyopathies).

2012: The update reviews 425.1 (now defined as Hypertrophic cardiomyopathy) so that it is no longer a valid code -- you should add a fifth digit for it to be valid:
425.11, Hypertrophic obstructive cardiomyopathy Hypertrophic subaortic stenosis (idiopathic)
425.18, further hypertrophic cardiomyopathy Nonobstructive hypertrophic cardiomyopathy.

The changes offer you one code meant for hypertrophic obstructive (425.11) and then the other code meant for other hypertrophic, containing nonobstructive (425.18). To follow with the changes to the 425.1x range, ICD-9 erases the terms "hypertrophic" and "nonobstructive" from under 425.4.

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