ICD-10-CM Official Guidelines: What’s New for Circulatory System Coding Rules in 2019

By Deborah Marsh, JD, MA, CPC, CHONC, senior content specialist, SuperCoder.com.

Have you reviewed the changes to the Circulatory System section in the ICD-10-CM 2019 Official Guidelines for coding and reporting? To support medical necessity and payment for your cardiology CPT codes and cardiology HCPCS codes, your ICD-10-CM coding needs to be spot-on. And that doesn’t mean just checking the ICD-10-CM index in your manual or cardiology coding tool. You’ve got to have the Official Guidelines down cold, or at least know where to find them when you need them. As you use the ICD-10-CM code set for 2019 cardiology coding, make sure you’re aware of these revisions to the Official Guidelines (OGs) so your coding complies with the rules.

Check for 2 Changes When Coding Hypertension with Heart Disease

In 2018, section I.C.9.a.1 of the OGs (Hypertension with Heart Disease) stated that “Hypertension with heart conditions classified to I50.- or I51.4-I51.9, are assigned to a code from category I11, Hypertensive heart disease.”

Watch out: In the 2019 OGs, the code listing changes to “I50.- or I51.4-I51.7, I51.89, I51.9.” You’ll continue to use additional code(s) from category I50.- (Heart failure), to identify the heart failure type, when applicable. What’s different? The change removes I51.81 (Takotsubo syndrome) from the guideline.

Clarity on when to code separately: The Hypertension with Heart Disease subsection gets an additional clarification for the instruction about when to code those heart conditions separately from the hypertension. The 2018 wording was “if the provider has specifically documented a different cause.” The 2019 wording is “if the provider has documented they are unrelated to the hypertension.”

See a Similar Documentation Clarification for Hypertensive CKD

 The Hypertensive Chronic Kidney Disease subsection sees an update like the one above for separate coding of hypertension and heart disease. Here’s the exact wording in section I.C.9.a.2:

Know Proper Sequencing for Pulmonary Hypertension

The 2018 OGs had incorporated changes for Pulmonary Hypertension (I27.-) in section I.C.9.a.11. A clarification in 2019 assists by better defining sequencing rules.

The 2018 OGs said that for secondary pulmonary hypertension, you should “code also” associated conditions or adverse effects of drugs or toxins and base the sequencing on the reason for the encounter.

The 2019 OGs revise the instruction to base sequencing on the reason for the encounter “except for adverse effects of drugs (section I.C.19.e).” The section referenced covers coding for Adverse Effects, Poisoning, Underdosing, and Toxic Effects.

Steer Clear of Subsequent AMI Coding Mistakes

Codes and OGs for myocardial infarction got a facelift in 2018, and the 2019 OGs continue to add clarification about how to code properly.

The new instruction added to section I.C.9.e.4 states, “If a subsequent myocardial infarction of one type occurs within 4 weeks of a myocardial infarction of a different type, assign the appropriate codes from category I21 [Acute myocardial infarction] to identify each type. Do not assign a code from I22 [Subsequent ST elevation (STEMI) and non-ST elevation (NSTEMI) myocardial infarction].”

The new instruction goes on to state, “Codes from category I22 should only be assigned if both the initial and subsequent myocardial infarctions are type 1 or unspecified.”

Consider I21.9 for Type 1 MI, Per ‘Other Types of MI’ OG

Another MI change is in Section I.C.9.e.5 for Other Types of Myocardial Infarction. The 2018 text that “Type 1 myocardial infarctions are assigned to codes I21.0-I21.4” gets the addition of “and I21.9” in 2019. The addition makes sense when you consider that I21.9 (Acute myocardial infarction, unspecified) applies to “Myocardial infarction (acute) NOS.”

Final tips: So, there you have it. If you want to support your cardiology procedure codes and comply with coding rules — and of course you do — make sure you’re up to date on the sometimes-surprising ICD-10-CM Official Guidelines for Coding and Reporting. You can find them on the CDC ICD-10-CM page, or you may have them handy in your online coding resource. Having the document in digital form makes it simple to use the find function to get to the diagnosis coding rules you need. Be sure to watch for bold text in the main content and italics in headings to help you identify changes so you can get up to speed fast.

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