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Unit 2 Summary 2.1 2.2 Answers

The document discusses various cardiac disorders including hypertension, ischemic heart disease, acute myocardial infarction, and their ICD-10 codes. It provides details on malignant hypertension, hypertensive heart disease, coronary artery disease, acute coronary syndrome, STEMI, NSTEMI, and examples of coding scenarios.

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22 views

Unit 2 Summary 2.1 2.2 Answers

The document discusses various cardiac disorders including hypertension, ischemic heart disease, acute myocardial infarction, and their ICD-10 codes. It provides details on malignant hypertension, hypertensive heart disease, coronary artery disease, acute coronary syndrome, STEMI, NSTEMI, and examples of coding scenarios.

Uploaded by

Jgg
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
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Unit 2 – Cardiac Disorders

Summary of Main Points (2.1 & 2.2)

HIMP 2210
Health Data Classification II
Hypertension

• “hypertension” = benign hypertension = I10.0


• Lead term: hypertension
• Secondary: unspecified or benign

• Never a type 2 diagnosis and rarely MRDx for inpatients

• “use additional code” for hypertension whenever documented


for conditions classified to blocks:
• I20 – I25 Ischemic heart diseases
• I60 – I69 Cerebrovascular diseases
• Dx typing will be either 1 or 3 (based on significance)
Hypertension

• “history of hypertension” = presence of benign hypertension

• Hypertensive renal disease = I12


• Dr. must document renal disease as due to hypertension or
hypertensive
• Must be a causal relationship, otherwise code each condition
separately
• “use additional code” for CKD (N18.-) or unspecified kidney
failure (N19), mandatory when documented

• Do not confuse with hypertension caused by renal disease = I15


• Secondary hypertension due to another disease
Hypertension

• Hypertensive Heart Disease = I11


• When Dr. states “due to hypertension” or “hypertensive”
• Cause and effect relationship between hypertension and heart
disease
• “use additional code” for heart failure (I50.-), mandatory when
documented.
• Dx typing depends on documentation

• If a person has both heart failure with hypertension, would you


code I11? No, no causal relationship. Code each separately.
Hypertension

• Malignant Hypertension = I10.1


• Documentation must state, “hypertensive emergency” or
“hypertensive crisis” or “hypertensive urgency”

• Hypertensive Heart and Renal Disease = I13


• When patient has both I11 and I12 use combination code I13
• “use additional code”, mandatory for:
• CKD (N18.-) or renal failure (N19)
• Heart failure (I50.-)
Ischemic Heart Disease/CAD

• Atherosclerosis of the coronary arteries due to plaque build up


• Reduces blood supply to the myocardium
• Can lead to rupture of atherosclerotic plaques with formation
of thrombi and total occlusion of coronary arteries
• Low blood supply, low oxygen of the myocardial cells leads to
ischemia and infarction

• Common term = CAD (coronary artery disease) = I25.1-


• Lead term: disease
• Secondary term: coronary
Ischemic Heart Disease/CAD

• Is a chronic or acute condition? Chronic

• Other common names:


• Atherosclerotic or arteriosclerotic heart disease (ASHD)
• Coronary heart disease
• Coronary vessel disease

• MRDx when:
• Patient book electively for coronary angiography or angioplasty
• Or emergent or elective bypass surgery
Ischemic Heart Disease/CAD

• Acute coronary syndrome (ACS) = I24.9


• Manifestations of CAD – unstable angina, myocardial infarction
• Condition is only coded without further specification
• Chronic coronary syndrome may mean stable or unstable angina,
must get clarification from physician before coding.

• Unstable Angina = I20.0


• Manifestation of CAD
• May be documented as the final diagnosis as reason for elective
diagnostic or therapeutic interventions but the reason for these
interventions is for CAD (I25.1-)
• Only code I20.0 when patient experienced at admission or during
their stay
Acute Coronary Syndrome = ACS

Chest Pain = ACS


Non-ischemic (e.g.
CT or TEE pericarditis) or Non-
ECG cardiac (e.g. esophagitis,
pulmonary embolism)

ST Elevations Non ST Elevations


[Partial obstruction with only
[Severe transmural ischemia]
some cell death]

Biomarkers = Creatinine kinase (CK-MB) and troponins (TnT or TnI)

STEMI + + - NSTEACS
-
NSTEMI Unstable
Q-wave(transmural) STEACS (non-Q-wave Angina
MI, MI)

Aborted MI
Refer to CCS pg. 619 - 621
Acute Myocardial Infarction = AMI

• Classified as acute when patient is admitted for treatment within 28


days of onset

• Coded to I21.- Acute myocardial infarction


• Lead term: infarction
• Secondary term: myocardial (transmural or non Q wave)

• Coder determines from documentation whether final diagnosis is:


• Transmural MI (Q wave) [STEMI]
• Subendocardial MI (nonQ-wave) [NSTEMI]
• Unstable angina
• Aborted MI
ST Elevation Myocardial Infarction = STEMI

• May be treated with thrombolytics via paramedics to


prevent/reduce myocardial necrosis

• Mandatory to code CCI for thrombolytics with pre-admit flag (Y)

• If myocardial damage prevented, diagnosis will be:


• Missed MI
• Aborted MI
• Averted MI (Pg. 764 CCS)
Code Sequence:
• I24.0 Coronary thrombosis not resulting in
myocardial infarction
• R94.30 Electrocardiogram suggestive of ST
segment elevation myocardial infarction
[STEMI] (dx type 3)
STEMI or NSTEMI

• NSTEMI patients may undergo urgent PCI or antithrombolytics or


anticoagulants

• STEMI patients may be treated with primary PCI (percutaneous


coronary intervention)

• CCI Code Sequence:


• Dilate coronary vessel(s) with or without removal of thrombus 1.IJ.50.^^
• Drug eluting stent (DES) is mandatory to code in CCI 1.IL.35.HZ-M8
• Coronary angiography (status attribute is usually DX) 3.IP.10.^^
NSTEMI Dx Codes

• NSTEMI
• +ve biomarkers, normal ECG
• Final dx = non-Q-wave MI

• Dx Code Possible Sequence:


• I21.4 (M) Acute subendocardial myocardial infarction
• R94.31 (3) Abnormal cardiovascular function studies (biomarkers or ECG)
suggestive of non ST segment elevation myocardial infarction [NSTEMI]
• I25.10 (1) CAD (if found and treated with dilation/stent)
• I10.0 (3) Benign hypertension
• E1-.52 (3) Diabetes mellitus with certain circulatory complications

• I10.0, E1-.52 are mandatory type 3 codes w/ I25.1.-


• R94.31 mandatory type 3 w/ I21.4
STEMI Dx Codes

• STEMI
• +ve biomarkers, develop Q waves
• Final dx = Q-wave MI

• Dx Code Possible Sequence:


• I21.0 – I21.3 (M)
• R94.30 (3) Electrocardiogram suggestive of ST segment elevation
myocardial infarction [STEMI]
• I25.10 (1) CAD (if found and treated with dilation/stent)
• I10.0 (3) Benign hypertension
• E1-.52 (3) Diabetes mellitus with certain circulatory complications

• I10.0, E1-.52 are mandatory type 3 codes w/ I25.1.-


• R94.30 mandatory type 3 w/ I21.0 – I21.3
R94.3- Pg. 233 CCS

• R94.3- Abnormal ECG is mandatory to code with:


• I21.- Acute myocardial infarction
• I24.0 Coronary thrombosis not resulting in myocardial infarction
• I22.- Subsequent myocardial infarction

• Lead term: abnormal


• Secondary term: ecg

• Type 3 diagnosis
STEMI Dx Codes

• STEMI
• +ve biomarkers, non-Q waves
• Final dx = aborted MI, if necrosis was prevented from early
intervention

• Dx Code:
• I24.0 (M) Coronary thrombosis not resulting in myocardial infarction
Example 1

A 79-year-old male patient was admitted to CCU through the


emergency department with a diagnosis of STEMI. He was given
thrombolytic treatment before admission with some resolution of his
symptoms. He remained in CCU for 3 days and was subsequently
transferred to the medical unit for a further stay of 4 more days. Final
diagnosis was recorded as AMI, posterolateral.

Dx Code Type Description


I21.2 M Acute transmural myocardial infarction of other sites

R94.30 3 Electrocardiogram suggestive of ST segment elevation


myocardial infarction [STEMI]
Example 2

A male patient presented with chest pain. His biomarkers were


negative and the physician noted there was some ST depression. There
was no relief of his symptoms with “pink lady cocktail”. He was
admitted to hospital with diagnosis of NSTEMI. He was seen by a
cardiologist who ruled out cardiac disease. Investigation by a
gastroenterologist revealed gastroesophageal reflux and esophagitis.

Dx Code Type Description


K21.0 M Gastro-oesophageal reflux disease with
oesophagitis
Example 3

A 78-year-old female patient was admitted to hospital with chest


heaviness and pain radiating down both arms. She stated symptoms
were worsening over the past 3 days. The physician noted her ECG
was normal but she had elevated troponin and CK-MB levels.
Subsequent ECG demonstrated damage to the anterior wall. Final dx:
anterior subendocardial MI.
Dx Code Type Description
I21.4 M Acute subendocardial myocardial infarction

R94.31 3 Abnormal cardiovascular function studies (biomarkers or ECG)


suggestive of non ST segment elevation myocardial infarction
[NSTEMI]

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