Keys to the Right Diagnosis Coding Diagnosis coding is the forgotten stepchild in medical practices. Physician coding has focused on Current Procedural Terminology codes, which drives revenue when services are…
Tip: A diagnosis that falls under an ICD-9 ‘other’ code may have its own ICD-10 code.
Under ICD-9, when the manual doesn’t offer a code specific to your diagnosis, you usually choose one of the catch-all “other specified” codes available, such as 425.4 (Other primary cardiomyopathies). When you start applying ICD-10 codes in October 2013, you may find that your catch-all code has been divided into more specific options. Here’s how the ICD-10 counterparts for 425.4 will look.
ICD-9 coding rules: Cardiomyopathy literally means disease of the heart muscle and can refer to many types of heart disease. ICD-9 offers one code for “other” primary cardiomyopathies: 425.4. It’s appropriate for cardiomyopathy NOS, congestive, constrictive, familial, hypertrophic, idiopathic, nonobstructive, obstructive (but see 425.1 for hypertrophic obstructive), and restrictive. Code 425.4 is also appropriate for cardiovascular collagenosis.
ICD-10 changes: ICD-10 divides your options for “other” cardiomyopathy among three codes:
Code I42.2 will be appropriate for other cardiomyopathy: hypertrophic, nonobstructive. Code I42.5 will be appropriate for other cardiomyopathy: restrictive, constrictive NOS. Code I42.8 is appropriate for any other cardiomyopathies not listed elsewhere, including newborn and obscure of Africa, as well as cardiovascular collagenosis.
Caution: Check the index and full I42.- range in the tabular list before choosing an “other” code. For example, several of the diagnoses that fall under 425.4 in ICD-9 do not fall under the “other” cardiomyopathy codes in ICD- 10. Specifically, obstructive cardiomyopathy is coded to I42.1 under ICD-10, congestive falls under I42.0, and familial and idiopathic fall under I42.9.
Remember: When ICD-10 goes into effect on Oct. 1, 2013, you should apply the code set and official guidelines in effect for the date of service reported. Learn more at www.cms.gov/ICD10/ and www.cdc.gov/nchs/icd/icd10cm.htm#10update.
Be ready...
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