Hey, good afternoon, everyone, we'll give it just a quick minute, let everybody get dialed in and connected, and then we'll get started. All right, we'll go ahead and get started. Good afternoon, everyone, and thank you for joining us today. My name is Jamie Quimby, and I'm a manager with Revenue Cycle Solutions Coding with MedAxiom. Today we're going to cover the fiscal year 2024 ICD-10-CM updates, which will be effective as of October 1st, which is in about 10 days. So all the code changes and guideline updates will be effective in 10 days. So we'll do a little housekeeping to start. So to access the slides for today's presentation, you want to click on the chat box and there will be a link there that will take you to the slides. Please do not use the chat box for anything else, especially questions. If you do have a question, you can type that in by selecting that Q&A box. As always, we ask that you keep your questions on topic and also know that we will answer as many questions as we can during today's webinar. But we will also compile them all and provide the answers in the Academy on our website in a Q&A document. For coding CEUs with our MedAxiom platform, our Academy platform, you can go in and actually claim your CEUs before we used to email them out. So please be aware, though, you must log into your MedAxiom Academy account and then you would click on the webinar that you attended. Then you would click on the claim CEU and then it will give you a PDF pop up where you could download that certificate onto your desktop or you could print it. Again, with our new platform here, we with the CEU process, we do ask that you give our team up to five business days to get everything loaded onto your account. Usually it happens much quicker within one to two. Also, a recording of the presentation will be added to the Academy as well. If you want to listen to it later, you'll have that option to do that as well. For CEU certificates, this is approved today for one and a half CEUs by the AAPC. If you're certified with AHIMA, they do accept the CEUs from the AAPC, so you can just enter that directly into your account. I have a AHIMA credential as well, and I enter them in all the time. All right, so today we're going to start with reviewing some of the updates to the fiscal year 2024 ICD-10-CM official guidelines for coding and reporting. I'm also going to highlight some of the important guidelines that are related to our cardiovascular reporting. We'll review all the individual coding chapter code changes, and we'll highlight our chapter, Chapter 9, in more detail. Then I'm going to end today covering some common cardiovascular diagnosis codes and go through some coding tips for some of those conditions. Just kind of a recap of how the changes look for this year. In this link here on the slide, this is posted from the CDC. Typically, they release the files starting in June every year for the fiscal year changes. If you click on that link, it's going to take you to the files that are available. They're very detailed. There's multiple to look at. The one that I always focus on that summarizes all the actual changes, and I'm going to drag this over to my page real quick, is this file here. This actually lists, if you can see, it has the additions, the deletions, and as you scroll down, if there's any revisions, it will show you what the code was revised from and then what it was revised to. This is how I look for all the changes every year that these are updated. It doesn't give you every single code in the book. There are files within this link, though, that do give you all the codes. If you aren't able to get a new book every year, this file is very, very resourceful because you can get a listing of every single code that's effective for the current year. But when I'm going through the code changes and I just want to see what was actually changed, that is the file that I just showed you that I go directly to. It's very detailed, very helpful. They also will release the official coding guidelines for coding and reporting. That's in a separate link here. Again, you can find this either on the CDC's website or you can find it on Medicare's website on the National CMS site. Summary-wise, we had 395 new additions for fiscal year 2024. They deleted 25 codes and the revisions were 13. Most of the revisions were either a misspelling in a word, so it wasn't anything significant. And as you can see, it wasn't anything where they needed to do a lot to. There were only 13 of those. But that does bring our total number for diagnosis reporting to 74,044. So we do have a lot of options. All right, so we're going to start with covering what some of the changes were in the guidelines. Some of this is not going to be related to cardiology, so I'm just going to kind of highlight it. But how you can tell when you're looking in the guidelines if there were any changes made to any section is this cover page here. This is how the guidelines start here. And they highlight here any changes and how you can tell. So any narrative changes, they will appear in a bold text. Items that are underlined have been moved within the guidelines since the previous year's version. And anything in italics is used to indicate that a revision was made. So they do make it simple as you're going through to kind of see what changes were actually made. Because as you know, if you've ever gone through the whole guideline for coding and reporting, it's many, many pages long. So it does make it easier to find if there are any changes there. So just to start, we did have a guideline change if you're reporting any screening for COVID-19. They do state, especially for preoperative testing, they do state you would assign the Z11.52 for that encounter for screening for COVID-19. Next, we do have a new code that we're getting this year. We'll cover that more when we get to the code changes. But this was a guideline update because of that new code. So we have a myocardial infarction with coronary microvascular dysfunction. You're going to commonly probably see it abbreviated as the CMD. So this will be added to our Chapter 9 coding. So what is this condition, though? So sometimes it's called a small artery disease or small vessel disease. It's defined as a heart disease that affects the walls and inner lining of tiny coronary artery blood vessels that have branched off from larger coronary arteries. So for fiscal year 2024, we will have a new code as I21B to report when this condition is documented by the provider. It does get further instructions that state you will assign the I21B is assigned for a myocardial infarction with that coronary microvascular disease. Or they may also call it myocardial infarction with coronary microvascular dysfunction. Or you might see it called myocardial infarction with non-obstructive coronary arteries with microvascular disease. So if you see any of that language from your provider, then you can map it to that I21B. These were some updates made to the coma diagnoses. Of course, we don't code too many in our cardiology world in this area. But it has to do whether or not the coma scale is documented in the record or not and what was the underlying cause. So, again, we don't really code in this area. So if you need to review these changes, they're right here for you to review in more depth. And then we also had an addition of a history of. So they added the Z9185 for personal history of military service. We also had an update to the guidelines for a follow-up. And the follow-up codes are used to explain continuing surveillance following completed treatment of a disease, a condition, or an injury. They imply that the condition has been fully treated and no longer exists. There were two updates in this section of the guidelines, the Z08 and then the Z09. Again, we're going to touch up on this when we get to the coding tips at the end because there is our CVA conditions that we typically see. I see miscoded a lot as we do, you know, coding work with client members and do audits for clients. So we'll touch up on that at the end when we get to the coding tips. And the last update to highlight is for the miscellaneous Z code reporting. The miscellaneous Z code captures, they capture a number of other health care encounters that do not really fall into any other category. Some of these codes identify the reason for the encounter. Others are used as kind of an additional code that provides useful information on circumstances that could affect that patient's care and treatment. So, again, there was a new addition added for coding, the Z91A, for caregivers' noncompliance with a patient's medical treatment and regimen. So those were the updates for the guidelines. So wasn't a whole lot. I want to touch up with you on some of our Chapter 9 guidelines. So no changes were made here, but it's something that I do like to revisit every year because it is an area that I see a lot of times not coded correctly. And a lot of that could be, you know, just based on the documentation, you know, there could be some improvement needed there. But hypertension is the biggest one. So what the guidelines state is that the classification presumes a casual relationship between hypertension and heart involvement and between hypertension and kidney involvement, as the two conditions are linked by the term with in the alphabetic index. So the conditions should be coded as related, even in the absence of provider documentation linking them together, unless the documentation clearly states the conditions are unrelated. And I can tell you, I don't see that too often where a provider will specifically state that their hypertension is not related to their congestive heart failure or their chronic kidney disease. So if there is no clear verbiage in your note that says they're unrelated, you do code them as related. So for hypertension and conditions not specifically linked by the relationship terms with that with or associated with or due to in that classification, again, the documentation would then need to link them together. But for this purpose, talking about our chronic kidney disease and our heart involvement, if the provider does not document them as unrelated, then you are to assume they are related. So furthermore, in depth, we'll start with covering the hypertension with heart disease. So this classification will assign you to codes of the I-11 series. You would also code from the heart failure category to identify the type of heart failure. So in an example here that I can give you, let's say a patient has hypertension and the provider also documents the patient has chronic systolic heart failure. So what the guidelines are going to take you to is you would code the I-11.0, which is hypertensive heart disease with heart failure. Then you would also code the I-50.22, which is your chronic systolic heart failure. You'll notice under the code in the I-11, if you go into the book, there's instructional notes under the I-11 that do tell you that you need to use the additional code to identify that type of heart failure. So that's why we would also report the I-50.22. Now, if you have a patient that has hypertension and chronic kidney disease, it's the same scenario as our heart failure. So you're going to assign a code from category I-12, which is your hypertensive chronic kidney disease. And then you're also going to assign the correct code for the type of chronic kidney disease the patient has. So example here would maybe be a patient that has hypertension, and maybe they have stage 2 chronic kidney disease. So you're going to code the I-12.9, and then you would also code your N-18.2 for that stage 2 chronic kidney disease. Again, if you go to the I-12 series in the book, it does give you those instructional notes that you would also code the additional code for the chronic kidney disease. Now, if you have a patient, say they're in the hospital, and they have hypertension, chronic kidney disease, but they also are in acute renal failure, the guidelines do tell you that you would code all three of those. They tell you to sequence the codes according to the circumstances of the admission or encounter. So you would do that based off what your provider's documentation would be. Most likely, your acute renal failure or acute kidney failure is going to be sequenced before your chronic kidney disease. But again, it's just going to depend on how your provider addresses the conditions in the note. Now, what if you have all three? So there is a combination code to report all three, whether a patient has the hypertensive heart and the chronic kidney disease. So this is all mapped to I-13 in the coding book. This will describe a patient with hypertension, heart disease, and kidney disease in this one category. Guidelines do instruct you. You would, again, report your I-13 series. You would also report your heart failure series, and you would report your chronic kidney disease series. So example here, let's say we have a patient with hypertension. Let's say they have a combination congestive heart failure with diastolic and systolic failure. Let's say it's acute on chronic, and then maybe they have end-stage renal disease where they're also on dialysis. So again, if you go to the instructional notes in the book, it does tell you under the I-13 series to code additional for the heart failure, for the chronic kidney disease. It also tells you to report their dialysis status, if known. So in this case, we would have the I-13.2 because we have the end-stage renal disease. We also have the I-5043, which is our acute on chronic combined heart failure. And then you would have your N-18.6, which is your end-stage renal, and then your Z-99.2, which is that renal dialysis status. Some other hypertension guidelines. If you have the transient hypertension, so this maps to the R039 for elevated blood pressure reading without that diagnosis of hypertension. Unless that patient has an established diagnosis of the hypertension is what the guidelines state. They give further instructions on if a patient is pregnant and is showing signs of the condition, it maps you to those correct codes to report. If you have controlled hypertension, the guidelines do direct you to assign the appropriate code from categories I-10 through I-15 for that hypertensive disease. Let's say they don't have any other conditions like heart failure or kidney disease, most likely you're just going to be walked over to the I-10 code itself for hypertension. If it's uncontrolled hypertension, it's the same thing. We don't have a code specifically mapped to uncontrolled hypertension. Guidelines in the book do also direct us to report the correct code from the I-10 through I-15 series. For hypertensive crisis, so this is assigned from category I-16 for hypertensive crisis or there's hypertensive urgency or there's hypertensive emergency or they may have an unspecified hypertensive crisis. You would assign the I-16 series appropriately depending on the specific type of hypertensive crisis they're in. You are also instructed to also code the type of hypertension. Let's say you report the I-16 code and they also have a history of hypertension. Then you're going to also report the I-10 code with that. You will sequence based on the reason for the encounter. Most likely if you're in the hospital setting and the patient comes in and they're having a hypertensive emergency, you're going to report that I-16 code first. Then you'll report the I-10 code if they have that known history of hypertension. Resistant hypertension, this refers to blood pressure of a patient with hypertension that remains above goal in spite of the use of antihypertensive medications. We are to assign the I-1A.0 for resistant hypertension. As an additional code when apparent treatment for resistant hypertension is documented from the provider. A code for the specific type of existing hypertension is sequenced first if known. You would sequence let's say the I-10 first and then you would do the I-1A.0 second if supported by documentation. Let's talk about coronary artery disease with angina. We have many, many different options to choose for reporting. We'll touch up on this at the end when we go through the coding tips and list them out. As you know, we do have combination codes. I do still sometimes see these reported separately. If you have the coronary artery disease with the unstable angina documented, you're going to map that to your I-25110. Then I'll see an I-2510 for coronary artery disease with no angina. Then I'll see an I-20.0 reported separately for unstable angina. Those will never be reported separately because of us having these combination codes available. If you have the coronary artery disease with angina documented, you're going to map that to your I-2510. Then I'll see an I-20.0 which will account for both of those. You cannot assume that if a patient has chest pain and known coronary artery disease that that would map you to the angina reporting. Your provider truly needs to document it clearly in the note if that chest pain is related to the patient having angina or not. If you question it, you can always query the provider or just have a conversation with them just to help yourself get further clarity on reporting the condition. Again, there's different options to choose from. Whether or not the patient has non-bypass grafts, if they are having that angina symptom, there's just different reporting options. We'll break this down later, though, when we get to the end of the presentation and go through the coding tips. Another thing I do want to point out here real quick, though. Say you have a patient that has non-bypass grafts. Maybe they're having symptoms of the angina, but the doctor documents in the note that their grafts are patent, meaning they're stable, there's no disease in that graft. Sometimes I see the code selected incorrectly, so it may be selected from the I-257 through the I-2581 series. These are the coronary artery disease within a graft and with the different types of angina that we code for. What you're telling a carrier when you report one of these codes in these series is that the patient has disease in that graft now. So if the provider documents that the grafts are patent, that means that they're stable and there is no disease. So this would not be correct to report. You would report the correct I-2510 series or in the series here for the I-10 or the I-11, and then you would report the Z-951, which is that presence of bypass grafts. So that's telling the carrier the patient's coronary artery disease is still symptomatic with the angina, but their grafts are patent and present. So that's why you would report the Z-951 instead of one of these codes telling them that their grafts are good. Acute MI, again, we're going to touch upon this later too with the different types of MIs, but just to give a brief recap of what our guidelines tell us in the official guidelines for coding and reporting. So for an acute MI infarction, for any encounters occurring while the MI is equal to or less than four weeks old, you would continue to report the code from the I21 series. Once that encounter goes past that four week timeframe and that patient is, excuse me, still receiving care, you would report the correct aftercare code. For old or healed MIs that no longer are requiring further care, that's when you assign the I252 for that old MI. Again, we're gonna cover the different types of MIs later in the presentation, cause there's type one, there's type two, there's type three. There's a bunch of different types now. So I'll go through each of those later and define what they all are. All right, so now we're gonna talk about the actual chapter coding changes. So remember we have 395 additions, 25 deletions and 13 revisions. A lot of this, we're just gonna do a recap on because some of it's not related to our cardiology world, but definitely wanted to highlight the changes for you all so you can see what all occurred. So for chapter one, there were two new codes added. As you can see here, chapter two had no coding changes and chapter three, they had two deletions with the addition of 21 new codes. These were all related to benign neoplasms within the digestive system, tumors or the sickle cell. And some of the deletions, they'll delete a code and then they'll add a bunch of more specified codes underneath that category. So that's what some of that was. Chapter four, there were three deletions with 18 new codes. This had to do with hypoparathyroidism and metabolic syndrome. Chapter five had no code changes. And then chapter six, we had two deletions with 24 new codes added. These had to do with Parkinson's disease, some epilepsy, different migraines, chronic migraines. So again, just a lot of that, just giving further specificity within those chapters. Chapter seven, they had one deletion with 34 new codes. Again, related to sickle cell, retinopathy, rectus muscle entrapment, and then foreign body sensations. Chapter eight had no code changes. This was actually the second year in a row that chapter eight has had no new updates or revisions made. And then chapter nine, this is what we wanna cover. So for chapter nine, we had three deletions, 10 new codes added, and then we had five revisions in our chapter. There was an addition of the I1A.0 for that resistant hypertension. The I21B, which we touched up on already as well for that myocardial infarction with that coronary microvascular dysfunction. They also added the I2585 if that patient has chronic coronary microvascular dysfunction. Then for the I20A, that was for our other forms of angina pectoris, that was deleted, but we got two new codes further specifying. So we got the angina pectoris with the coronary microvascular dysfunction, and then they just added, the I208 basically went to the I2089 for that other forms. There was a revision made to the I25112. It was a very tiny minor revision. They changed, so last year, the T in atherosclerotic was an S. So they just changed the S to a T this year. So again, just a minor revision to the code. And then they did delete the I248 as they did with the I208 and just gave further clarity. So we have now acute coronary microvascular dysfunction, and then we have the I248 that went to the I2489 for the other forms of acute ischemic heart disease. And to continue, we also had a deletion of our SVT diagnosis. They deleted the I471. If you remember last year's changes, they did this to the ventricular tachycardia diagnosis where they deleted our I472 and they gave us further more specified diagnoses to report. So same thing happened here with our SVT this year. So the I471 is deleted, but we have the addition of three more specified codes. So we have I4710, which is an unspecified SVT. We then have I4711, which is for inappropriate sinus tachycardia, so stated. I am actually starting to see this documented a lot more from physicians. So I am glad this has a new code starting in the next 10 days. And then an I4719 is for another supraventricle tachycardia. So if they do give you a specified SVT, you can map it to the I4719. Revisions, we had some made here. All they did is they added the thoracotomy abdominal aorta. So last year, all it said was abdominal aorta. So that's all they did was add that language to it. So tiny revision again. And that was all of our chapter nine. So they definitely have been kind to us in the last three or four years. They have given us a ton of changes. Some of them were needed though. I think with some of the arrhythmia stuff, that's all been good changes to give us more clarity and more detail to report. So chapter 10, this one had one deletion with seven new codes, had to do with pneumonia or the oligarch syndromes. Chapter 11 of the digestive system, this had two deletions with 17 new specified codes. These all had to do with acute appendicitis, small intestinal bacterial overgrowth, short bowel syndrome and intestinal failure. Chapter 12 had no coding changes. Chapter 13, this one had 36 new codes. So no deletions, but what they did is they added a lot of more specified codes for age-related osteoporosis that has a current fracture or other osteoporosis with current fracture. So there were again, 36 new codes added to those two categories. For chapter 14, there were two deletions with 15 new codes and one revision. Again, we don't code too often from this section unless they have chronic kidney disease, but there were no changes with that. So this has to do with nephropathy or nephrotic syndrome. So again, 15 new codes there. Chapter 15, this one had one deletion with six new codes. Again, having to do with either a pregnancy or a syndrome following labor or postpartum acute kidney failure. Chapter 16 had one revision. Again, minor change just due to a spelling error or a letter that they changed within a particular word. Chapter 17, we do code out of this sometimes for congenital cardiac anomalies, but there weren't any code changes or new codes added for this. There were some congenital malformations of the liver added. 22 new codes were added to this chapter, but again, most of that had to do with the congenital malformations of the liver. And there were some revisions to the Marfan syndrome. All they did was remove the S. So it said Marfan syndrome. So now they just, again, it was this typing error or whatever from the previous year, but they removed that S. So that was the tiny revision made there. Chapter 18, so this one had 104 new codes. These chapters always are a little bit, you know, entertaining when I'm reading through them to see what was changed. So they added 104 new codes to our symptom signs and abnormal clinical findings. Nothing related to anything that we would really pick in cardiology though. So 104 new codes added. All these are related to foreign body sensations, whether it's either unspecified, it's to the patient's nose, maybe to their throat or an other site. And then they also added multiple codes for mammographic fatty tissue. Again, so not anything we're really gonna code, but it did, again, have 104 new codes added just related to those two topics alone. Chapter 19 had 12 new codes. These were all related to toxic effect of, and I'm not gonna butcher that word, but they were all related to this. And again, 12 new codes added there. Chapter 20. So this one was definitely entertaining to read through. So there are 123 new codes. So the most out of any chapter. These all have to do with a foreign body entering into or through a natural orifices. And they specified the foreign bodies being all of this that I have in parentheses. So it had to do with a battery, a plastic, a glass, magnetics, metal, non-magnetic metal, rubber bands, food, insects, which I don't even wanna think about that. So audio device, or they had a combination of metal and plastic, a needle, a knife, or a sword or dagger. So 123 codes added to that category just related all to that. Chapter 21. So this had six deletions with 30 new codes added. Again, a lot of this not related to anything we report, but it had to do with encounters for prophylaxis, child in custody, a child conflict. And they specified further whether it's a parent, a step-parent, a non-parental relative, a non-relative guardian, or a group home. So most of those additions were to that. Family history of colon polyps were added. And then that caregiver's non-compliance with that patient's medical regimen. There was also non-compliance for renal dialysis and other medical treatments. And then chapter 22, that was added a few years ago when the COVID pandemic happened. There hasn't been any coding changes made. They added it that first year, and then they added a couple codes the second year, but there's been no changes to it since. And that ends our coding updates per chapter. So now we're going to cover some common cardiovascular codes that we see, and I'm going to give you some coding tips for some of those conditions. So preoperative clearance. So this is one we see a lot. The thing with preoperative clearance that you have to remember is that the carriers are very specific with how they want this code sequenced. So if you go into your ICD-10 book and you look in the back of it where all your appendix are listed, in appendix D, they actually list all the Z codes that are allowed to be listed as the primary diagnosis on the claim. Any of your preoperative clearances are definitely on that list. So if you're seeing a patient in a clinic setting in your office, or whether it be a hospital consult for a surgeon needs clearance for a patient, that Z code should be listed first if that is the primary reason you are seeing that patient. Then what you want to list second as your diagnosis is the reason the patient's having surgery if that's documented clearly for you. Sometimes it's not going to be cardiac related, but that's still okay. You're still going to sequence it in that way. Then what you list additionally in your third and beyond spots is any cardiac conditions that your provider is addressing in that visit. So again, that's the correct sequencing for pre-op visits. Some carriers will deny if they see that encounter for the Z01810, for example, if they see that diagnosis on the claim, and it's not first, a lot of carriers will deny that claim. So keep that in mind. You definitely want to list it first if that is the reason you are seeing your patient. Vowel disease, this is always a hot topic. So especially when you're looking at an echo report and you're looking at findings. So they really, I wish they would update the guidelines to these, but they have not. So when you have a provider document, a lot of them are not detailed. They don't say non-rheumatic or rheumatic. The thing about coding bowel disease is when you have multivalve disease and you go into your index and it's guiding you to the codes to report, when you have multivalve disease listed, the index is going to guide you to the rheumatic disease codes. So that is what you are to report. Now, if they specifically state non-rheumatic, then that's great. You can report the non-rheumatic bowel disease for each individual valve, but they would have to say that. Now, what we see with some of our member practices that we work with, their compliance team has put in a policy that states that bowel disease is to be coded non-rheumatic unless that provider specifically states rheumatic disease. And the reason why some of these policies are put in place, if you have had the opportunity to talk to your providers about this specifically, they will tell you that rheumatic disease is not common in the United States. I've had many providers tell me that. And some providers get angry if they see you reported, if they see that you reported rheumatic disease on their claim, because they're like, my patient doesn't have rheumatic disease. And I'm like, I understand that. But you didn't say non-rheumatic, there's no policy and the patient had multivalve disease. So I have to, that's what I have to code. So just keep that in mind. If your practice does not have a policy set in place like that, then again, you're going to be guided to the rheumatic combination code. So for example, here I have on the slide, say your echo shows you have mitral insufficiency and tricuspid insufficiency. The provider didn't state non-rheumatic. So when you go on your index under insufficiency, you're going to see the index guide you to the I08.1, which is rheumatic disorder of both the mitral and tricuspid valves. So again, talk with your providers, you know, see if your compliance team has got a directive out on this, you know, otherwise you'll be driven in the index to go code the rheumatic disorders. This is only when multivalve disease is involved. Now, if it's a single valve disease and you go to your index, it's going to guide you to the non-rheumatic section. This is why I wish they would make a revision to the guidelines and update this, but this is what we have currently. So again, just talk with your providers, talk with your administration, your compliance team. And again, like I said, a lot of practices that we've worked with, they have put compliance rules that they follow for this particular condition here. All right, let's move on to our acute MI. So we're going to define what each one is first. So with there being so many MI codes to choose from, we're going to touch up and first define what they all are. So a type 1 MI is defined as a spontaneous myocardial infarction. This is an event related to atherosclerotic plaque rupture, ulceration, fissuring, erosion, or dissection with resulting in that intraluminal thrombus in one or more of the coronary arteries. This does lead to decreased myocardial blood flow or that distal platelet emboli. The patient may have underlying severe coronary artery disease, but there are times where, and the data shows anywhere from 5% to 20% where the patient has non-obstructive or no coronary artery disease found to be on that coronary angiography. Particularly, this is found in women. Myocardial infarction secondary to an ischemic imbalance is defined as our MI type 2. This accounts for up to 25% of all MIs. In instances of myocardial injury with that necrosis where a condition other than coronary artery disease contributes to an imbalance between the myocardial oxygen supply and or demand, typically your provider will define that as a type 2 MI. In critically ill patients or patients undergoing a major surgery, sometimes the elevated values of the cardiac biomarkers may appear. Sometimes this is due to direct toxic effects, just many different variables here. Also coronary vasospasm or endothelial dysfunction have the potential to cause this type of MI. So again, just providers are really good. I see that where they will specifically document the type of MIs, but just so you know the difference there and how they're defined. So acute MI type 1. So we have different options to report these. There's different subcategories to these based off of the site of the MI. So you can have like an anterior lateral wall, a true posterior wall. They will also map you to the vessel. So whether they have an MI to the LD vessel where that's the culprit, those types of things. Your providers are typically pretty good. Most times you're gonna find that detail in your cath report. So if the patient comes in through the ED, they've activated the cath lab, they bring them urgently to the cath lab. Usually your provider will see the patient quickly and then determine like they're in acute MI, they need to go to the cath lab urgently. Usually you're gonna find the details of the type of MI in your actual cath report because at the time they're seeing the patient for the HNP or the admission, a lot of times they don't know yet. They just know the patient's in an active heart attack and there's an urgency to get them to the cath lab to get them stable. So code I21.4 is used for a type 1 non-STEMI. So if a type 1 non-STEMI evolves to a STEMI, to a STEMI, you would assign the STEMI code. So STEMI 1 trumps the type 1 non-STEMI code if both are supported in the documentation. Remember though, the acute phase of an MI is four weeks or less. So once that four week timeframe hits and the patient's no longer requiring further treatment, you would then crosswalk that STEMI code to the I252. Now we also have a type 2 MI. So this maps to I21A, A1 or I21A9. So they added these probably like three or four years ago now, but they did add this category here. They further define the different types of MI. So type 2 MI is a myocardial infarction that is secondary to an ischemic imbalance. In instances of myocardial injury, again with that necrosis where the condition other than CAD contributes to that imbalance. Again, sometimes this applies to critically ill patients or maybe they've undergone a major surgery or just different circumstances can cause this type 2 MI. If your provider does clearly document type 2 non-STEMI, because I do see that often in reports, that's when you're going to report your I21A1. Now the I21A9 is any other type of type 2 infarction. So there's different types. So there's types three through five here that are defined. So a type 3 MI is the result of a coronary thrombus with sudden cardiac death before the biomarker results are available. A type 4 is caused by complications of a PCI, so that intervention. So a 4A is for a periprocedural MI. A 4B is related to an instant thrombosis. A 4C is an MI that is due to a restenosis greater than 50% after initially successful PCI. And then type 5 is related to complications of a coronary artery bypass surgery. I haven't used these types personally often. The one I see common is your type 2 non-STEMI. That's the one I see the most. But if your provider does document this detail, that's when you would map it to the I21A9. All right, so then we have demand ischemia, and then we also have myocardial injury that's non-ischemic. So we'll define what these are. So the demand ischemia is a specific type of ischemia where the oxygen requirements of the myocardium are not being met due to some increased need. It may occur in patients with an infection, anemia, or maybe a tacky arrhythmia, and then a non-ischemic myocardial injury. It simply means there's an inadequate oxygen supply to the myocardium without damaging the myocardial cells. The myocardial injury in the absence of that ischemia is categorized as acute or chronic or unspecified. The acute myocardial ischemia is evidenced by symptoms or an EKG change or cardiac imaging that was done. Sometimes the troponin is also released, and if it's above the 99th percentile, a myocardial infarction has occurred. Again, it's up to your providers to document this level of detail for you. I'm definitely not clinical. I like to look up a lot of diagnoses just so I understand it better. It helps me code better. I definitely encourage, if you're not too familiar with the condition and you see your provider talking about it in the note, and maybe you can't meet with him to talk with him about it at that time, do some research, see what the condition is about. It'll help you understand it more and code more accurately. All right, so coronary artery disease. Again, so many reporting options depending on the level of detail. We have CAD without our angina. So this is all the codes available depending if it's just in their native coronary artery, if they have it within a bypass graph, if they have it within a transplanted heart, or if they have it within a bypass graph of a transplanted heart. So again, different reporting options depending on the level of detail you have. Then you have them with angina here in these two categories. So this goes off of the type of graph that the patient has or doesn't have. So the I2511 series is a patient with just coronary artery disease and their native vessels with the angina present. Of course, there's more specified depending on the level of specificity you have of the type of angina. Then you have the I2570 series, which is your coronary artery disease within a bypass graph, but it's unspecified of the graft. Most times you're gonna have that level of detail in your notes. So you would be able to code it more specified. Atherosclerosis, the I2571 series is of a vein graft. And the difference here with the autogenous graft, so what that means is the tissue is harvested from the person who is also undergoing the graft procedure. So that means it's their vein. Most times I can't even think of when I've seen a provider document that it was non. So most times if you're doing it within the vein or artery, it came from that patient most times within that note and the provider will document that, they'll say where their grafts came from and all that detail. But if they have the angina present and it's within a vein graft, the disease is within the vein graft, that's when you would report here. The I2572 is when it's within an artery bypass graft. So sometimes when they do the CABG procedures, they're gonna do it from a artery, sometimes they do it from a vein, sometimes they do it from both. The I2573 series, that's when it's not from the patient's body. So it came from somewhere, maybe another person. So that's when you would report the I2573 for the coronary artery disease. And then the I257, that is within a transplanted heart. The I2576 is disease within the bypass graft of a transplanted heart. And then the I2579, that's just other coronary artery bypass. I don't think I've ever reported this code because normally you have that level of detail documented. And then if you have a patient that has known disease, they came to the cath lab, their symptomatic provider brings them in for another coronary angiography and they had previous stent placed in maybe multiple vessels, but let's say the vessel of the LD now shows that there's disease within the stent. So that's gonna be called an instant restenosis. If you have that, then you would report your T82855. And then again, there's further specificity. An A would be for an initial visit. The B would be for a subsequent. Most times, if you're bringing them in the cath lab and you find out at that time, it's gonna be mapped to the A for your last character there. But that will report that the patient has a coronary artery disease that is now within their actual stent. All right, so now we're gonna cover some of the different types of arrhythmias because there are so many to choose from. And if you love coding EP like I do, it's definitely helpful if you understand all the different conditions because you do code for them a lot. So with sinus bradycardia, we know if we're doing like a pacemaker implant, like the R001 is not gonna fly. Like the carrier's not gonna pay just for that. There has to be more specificity. What type of sinus bradycardia do we have? So sometimes you don't have that level of information though in your report. So sometimes you may have to report that. But sinus bradycardia disease, the R001 is really kind of an unspecified bradycardia. But defined wise, it's when a person has a heart rate of less than or 60 beats per minute. Sometimes a slow heart rate might be normal for that patient though. So it doesn't always mean like if it's less than 60 beats per minute for that patient, like they're gonna be at risk and they need a pacemaker urgently or anything like that. Sometimes it's just normal for some people to have a slower heart rate. So this type of not really being specified is not likely to cause complications until that heart rate starts getting very slow. They define that as usually being 40 beats per minute. It rarely requires treatment unless it is causing symptoms. Then at that time, that's when your provider may start looking at placing that pacemaker. Again, typically they're gonna have more specificity involved with that. Sinus pause, which is also called a sinus arrest. This is during a sinus pause, the heart may miss one or more beats because it's natural pacemaker is failing to activate the electrical system throughout the rest of the heart. So depending on the cause of the sinus arrest, there could be a risk of complications with that type of bradycardia. So a lot of times when I see a provider document, a patient had sinus pauses, usually the underlying reason for that is they have sick sinus syndrome. So again, it would be up to your provider though to document that level of detail. That's just what I commonly see when I'm coding EP. And usually the providers are very detailed with further defining that they had a sinus arrest, but it was due to the patient's underlying sick sinus syndrome. So covering sick sinus syndrome. So this happens when the normal pacemaker of the heart, which is the sinus node is not working properly. Various irregular heart rates or arrhythmias or combinations of that arrhythmia can happen. So sometimes patients may have underlying AFib, but on medications that they're on, it is causing them to go into bradycardia. So there could be some other issues that are arising from that. And then that brings us to tachybrady syndrome. So you can see these both map to the same code in the ICD-10 book. But tachybrady syndrome is a little different than just sick sinus syndrome. So in tachybrady syndrome, that's what I was just talking about. This is where sometimes the heart is beating too quickly, and then sometimes it beats too slowly. So they're having a combination of both conditions. Commonly, we see this in patients with AFib. And again, a lot of times it could just be the medical management they're on with the type of medication. Sometimes a provider will try to change the medication or the treatment plan to see if it improves. But if they can't keep their AFib under control, which is gonna put them at risk for stroke, then that's when they may consider pitting the pacemaker in place. So that way it stabilizes that patient's rhythm. So again, just varies. And then lastly, we have heart blocks. There's many different type of heart blocks documented within the note. So again, it's up to your provider to document that level of detail. But normally with a heart block, the electrical impulse from continuing through that normal pathway, and usually it will result in a slower heart rate. There's a complete heart block, which is the more severe of them all. Usually if you're in a complete heart block, the provider's pitting in a pacemaker pretty quickly. But there's sometimes type one, type two. So it just depends. It's different stages of it. Sometimes they may not specify too. So sometimes maybe the patient's new, they have a history of from another provider. So maybe they have to do further assessments on the patient. So again, level of detail is very important though when you're looking at bradycardia, especially if you're placing that pacemaker. Cause like I said, just the R001, it's not gonna meet the Medicare requirements for the implant. Now, different SVTs. So, you know, we got the new code coming up for this year in 10 days. So if you have a specified SVT, that's when you can code the other specified, the new code. But if it's not really further defined, it just says patient with a history of SVT, that's where I would choose the unspecified. But typically the most common SVTs that I see is atrioventricular nodal reentrant tachycardia or I'll see them document atrial tachycardia. With the inappropriate sinus tachycardia, that's gonna be a new code we're getting this year. So this diagnosis requires exclusion of other causes of the tachycardia. So they'll exclude seeing if it's medications or substances such as like a beta blocker or caffeine or maybe alcohol, or they'll look and see if there's a medical condition such as a panic attack or maybe the patient had a pulmonary embolism, just something to see that is causing that inappropriate sinus tachycardia. Again, I'm starting to see providers document this in the note more clearly. So I don't think there'll be any question. Like if you do see the inappropriate sinus tachycardia documented, you'll be able to map this to the new code that we have coming up. For atrial flutter, we have three reporting options. We have your typical, your atypical or your unspecified. Most times, if they don't clearly document the type, then we're coding unspecified. But to help you understand the different types, and again, talk to your doctors too, because I mean, I find when you go to a provider and ask them questions, they truly appreciate that because they see that you're wanting to understand what they're doing, how they document in their note. So that way you're coding it accurately. And providers do see that when you question stuff because they know we're not clinical too. Not most of us. I know there are some coders out there that have a nursing background. But looking at the different types of a flutter. So type one, which we define as typical, or type two is defined as our atypical. So these are based on the anatomic location from which it originates. So also atrial flutter can be described as clockwise or counterclockwise, depending on the direction of the circuit. With typical a flutter, this is localized to the right atrium and typically can be treated with an ablation procedure. So that might be where you see the provider doing a CTI ablation. Normally that is done due to typical a flutter. Atypical a flutter is localized to the left atrium. Most types of this flutter can also be treated via ablation, but it's a more complex procedure and gonna be more involved. So if they have atypical flutter, it's a more complex procedure than a typical a flutter procedure. And then we have AFib. So we have lots of reporting options for our atrial fib relations. So with proximal AFib, a patient may have symptoms that come and go, usually lasting a few minutes or up to a few hours. Sometimes symptoms occur for as long as a week. Episodes can happen repeatedly. Your symptoms may go away on your own or you may end up needing treatment. With persistent AFib, this often requires a pharmacological or electrical cardioversion. And it doesn't always stop within a week of being present. Longstanding persistent AFib, this is persistent and continuous and will last longer than one year. Again, this is all up to your providers to document this level of detail for you. But I, again, understanding how these conditions are defined will help you. So with chronic AFib or permanent AFib, this is a term that is used to describe the condition in people where the abnormal heart rhythm cannot be restored. They'll most likely have the AFib permanently and often require medications to control their heart rate and to prevent that blood clot. Usually with chronic or permanent cardioversion, most times it's not even attempted or if they do, sometimes it's not successful. So these are hard to control once you get into the permanent or chronic category. Again, I stress to you, it's up to your providers to document that level of specificity for this condition. We, of course, also have an unspecified AFib. So this may be a patient that's brand new to the provider. Maybe they came into the hospital and were found to be an AFib. So it may be a true scenario where it is unspecified because they haven't done workup yet on the patient to further define it. Different types of ventricular tachycardia. So remember, we got these codes last year for fiscal year 2023, where they deleted our I472, but then they gave us four new codes to choose from. So ventricular tachycardia, it's a rapid heart rate, more than 120 beats per minute. It originates in the ventricles, which are the lower chambers of the heart. When the heart beats too fast, there's inadequate time for those chambers to fill between the beats, which results in that less oxygenated blood that's being pumped to the body. This is a very serious condition. Sometimes patients have to have a defibrillator placed. They definitely require urgent treatment to get it under control. There are different options of the VT, just depending on the level of specificity that you have documented in your note. All right, our ventricular flutter or fibrillation. These definitely are life-threatening conditions and they require immediate attention. So with V flutter, this is an extreme form of ventricular tachycardia with the loss of organized electrical activity. It's often associated with a rapid and profound hemodynamic compromise. Usually it is short-lived due to the progression. It usually will progress from V flutter to the ventricular fibrillation. And again, this is a life-threatening condition. With ventricular fibrillation, it's the most important shockable cardiac arrest rhythm. The ventricles with this condition suddenly attempt to contract at rates up to 500 beats per minute. This rapid and irregular electrical activity renders the ventricles unable to contract in a synchronized manner, which results in the immediate loss of that cardiac output. Usually this does require advanced life support to get the rhythm under control. Otherwise it can be fatal. Congestive heart failure. So when I was putting this presentation together, I came across some really good information from a provider and I was like, I'm just gonna share this because I learned so much just going through it myself. So with congestive heart failure, you know we have so many codes to choose from now, whether it's the site of the location, the cause, the severity. I mean, there's so many different reporting options now. So sometimes one thing I wanna point out here is if you go to your ICD-10 book and you go to the actual congestive heart failure codes, not the index, but actual codes, if sometimes what I see in a report now is I'll see HFREF documented, or I may see a P instead. So the actual ICD-10 book actually has this abbreviation in the book with that diagnosis. So the R means it's a heart failure with a reduced ejection fraction. So that will map you to systolic heart failure. Diastolic heart failure will map you to heart failure with a preserved ejection fraction. And then you also have options for the combined. So patient may have both. And again, that is up to your provider to clearly document those clearly. You also have options of severity, whether it's acute, whether it's chronic, whether it's acute on chronic. Sometimes that level of specificity may not be known yet because maybe the patient's new to your provider. So there may be occasions where you do have to report an unspecified, maybe diastolic heart failure, but it's unspecified because you don't know yet whether it's in an acute phase, a chronic phase, or maybe they're having both at the same time. And then there's also in-stage renal, or not in-stage renal, in-stage congestive heart failure code now too. But we'll further define what these mean. So last year, the ACC and the AHA, they got together and kind of redefined and categorized these for us to kind of help better understand. So stage A heart, if it's listed as stage A, it means the patient is at risk for heart failure. What that means is they're at risk, but currently without symptoms, structural heart disease, or blood tests indicating heart muscle injury. This includes people that may have high blood pressure, diabetes, metabolic syndrome, obesity, maybe exposures to certain medications or treatments that may damage the heart. So example here would be some of the high toxic medications that some of our patients have to take. Maybe if they have cancer and they're on chemotherapy drugs, those are toxic and can cause issues. Some of the antiarrhythmia drugs are also toxic. So again, sometimes they could be at risk for the heart failure, just based off of the medications they're having to take. For stage B, this is pre-heart failure. So it means no symptoms or signs of heart failure, but they do have evidence of one of the following. So they may have a structural heart disease. They may have a reduced ejection fraction. Maybe they have enlargement of their heart muscle, what we typically see called maybe left ventricular hypertrophy or cardiomegaly. Abnormalities in the heart muscle contraction. They may have valve disease. So again, just different factors could hit them at that pre-heart failure stage for stage B. Stage C is symptomatic heart failure. So this means patient has heart failure. They know it's there, it's present. Typically the patients will have that structural heart disease documented with current or previous symptoms of the heart failure. Symptoms range, of course, depending on the patient. It could be shortness of breath. They could have a persistent cough. Maybe they have swelling. Typically it could be caused from edema that's in their extremities. Sometimes in their abdomen, the swelling can occur. A lot of times they're fatigued and then sometimes even nauseous. Stage D, this is advanced heart failure. So this is heart failure with symptoms that interfere with the daily life of the patient and they are very difficult to control, which results in recurrent hospitalizations despite continuing that guideline-directed medical therapy. So these are the different types of heart failure we have to report. And so I put this slide together just defining the different types and just going through the specifics to try to help. So again, the heart failure reduced ejection fraction. This is defined clinically of an EF that is less than 40%. Again, it's up to your provider to document the level of acuity and it's going to map you to the I50.20 to the I50.23 series just depending on the level of acuity. Heart failure mildly reduced ejection fraction that is going to be defined as an EF that is within the 41 to 49 percent range again depending on the acuity. Coding Clinic back in 2020 did put out clarity in the third quarter. They do state that this would map to I codes I50.21 through the I50.23 again just based on that acuity being documented. Heart failure improved EF that's what the IMP means so this means that the EF has improved from less than 40 percent to above the 40 percent range. Depending on how much it's improved and what level of detail your provider documents it's either going to map still to your systolic heart failure or if it's gone up above that 50 percent range then it may map to the diastolic. It's really up to your provider to document that clearly in the note you can't just assume that with this section here. Coding Clinic again did state in that third quarter you would code it as chronic diastolic heart failure for an improved EF that is above 50 percent. If it's not above that 50 percent range it would most likely still crosswalk to the systolic heart failure. The heart failure preserved EF so this maps us to our diastolic and again this is defined as the ejection fraction being 50 percent or above. You're going to base it on the acuity level you know to the I5030 through the 33. Then we have a combination so sometimes a patient may have systolic and diastolic heart failure. Typically providers are very clear when they when that's present they will state that again these are based off of the level of acuity and these map to the I50404 series. Biventricular heart failure so this is right heart failure with left heart failure with specification of the type of left heart failure. So if the patient maybe has biv heart failure with the the right heart involvement and maybe they have systolic heart failure too so you would be coding the I5082 and then you would also code the specified left heart failure. So if they had that systolic present also you would code the I502 series depending on the level of acuity documented. Then with our end stage heart failure this is going to fall under that stage D that we just defined in the previous slide. This is marked heart failure symptoms that do interfere with the daily life and it typically causes that recurrent hospitalization. Typically this is only mapped to chronic or acute on chronic in the in the book but are clinically when the providers are documenting it but you would code the I5084 series along with the specified type of heart failure that the patient has. Right heart failure this is isolated right heart failure or right heart failure that is due to left heart failure. Again based on the acuity is how you report it if it's acute chronic or acute on chronic this does map to the I50810 to the 814 series and then lastly we have high output heart failure. So this is specifically underlying etiology causing the high output heart failure. There is no specified type as far as the acuity goes so this does only map to the I5083 code itself whether it's acute chronic or unspecified. If you see the high output documented it would go to the I5083 code. All right so CVA so I briefly brought this up when we were talking about the the official guideline for coding and reporting earlier. I do see this coded miscoded often so the only time you're going to code the CVA code the I639 is when that patient is in an acute phase of that CVA and they're receiving treatment. So if they don't have any like residual effects and they're discharged from the hospital they're coming in for follow-up everything's stable you do not code the I639 that's telling the carrier the patient is having an acute CVA. So what the IC10 guidelines do tell us is that when a patient has made a recovery from a CVA and they have been discharged and they're being seen for follow-up you will code the Z8673 for the history of. Now again if they if they have residual effects from that CVA you're going to code the correct code from the I69 series still it just depends on that documentation. I can tell you more times than none it's typically the patient had the CVA they're stable no residual effects they're coming in for just regular follow-up in the office and I still see the I639 coded so just remember that's telling the carrier it's an acute CVA and they're having a CVA in the office setting which is not correct so you'll want to cross off that to the Z8673. Sometimes too I see like a patient had a CVA they're being seen by EP because sometimes a CVA can be caused from a patient have an underlying atrial fib. So sometimes maybe the provider wants to do an implant of a loop recorder right so you're okay to report that loop implant with the Z8673 that's still telling the carrier you know the patient had a CVA the provider's implanting a loop recorder to surveil them to see if maybe the patient has underlying atrial fib. So you're okay to still report Z code in that case. In the actual guidelines themselves in the ICD-10 guidelines it does state the personal history codes explain that a patient's past medical condition is no longer existing and is not receiving any treatment but has the potential for reoccurrence therefore may require that continue monitoring. So that's why you would report that Z code instead. All right now we're going to cover just briefly some key documentation points. So when you're looking at education both with clinicians and coders you know there's a need to understand the basics of accurately reporting a diagnosis code. Obviously variables change depending on the documentation the level of specificity that you have all that all that has to be factored in. It's important though for the providers to understand that you know documenting that level of specificity is needed. When you're looking you know at risk adjustment coding itself with reporting your diagnosis codes not all codes in the ICD-10 book the 74,000 plus that we have not all of those codes will map to an HCC code for risk adjustment reporting. So it's important to have that level of specificity documented in the note. So these are just kind of some you know documentation improvement type examples here. So maybe a provider instead of just documenting coronary artery disease with angina maybe they just give us more specifics. Maybe that patient has a known coronary artery disease maybe their angina is in a stable phase. So that's going to map to that I-208 or the I-25 you know 118 series. And maybe they're managed on nitro at you know just PRN. History of CHF they're managed on LASIX. Well what type of CHF? So CHF should always be known unless the patient's brand new to the provider and that they're having to do workup to further define it. In cardiology it should be rare that you see unspecified CHF in in your reporting. So in this case you know maybe the patient has diastolic CHF and let's say it's chronic and it's stable on being managed on the LASIX medication that they're on. Same with COPD you know just documenting that further clarity the COP is what PD is well controlled and managed on their medication. So again just that little bit of level of detail can definitely help when the coders are trying to accurately assign the coding. So there are a couple acronyms that we use when we are looking at diagnosis reporting. A lot of times we apply these to evaluation and management know whether or not we're trying to figure out what conditions to report. You have to remember though with some of this if the condition is not addressed like as far as you have the stability of the patient or the specific condition how it's managed those types of details you know you're you can't report every single diagnosis code. It's not enough just for the provider to list diabetes in the assessment and plan but then not go into further clarity. Well is the diabetes stable? Is it unstable? You know who manages it as a patient's primary care provider? Are they managed on insulin? Like those types of details are needed. If they just list the diagnosis code itself and that's it you can't report it on your claim and you can't account for it in your medical decision making you know because you have no details of that condition. So we use two helpful acronyms when looking at this. The first one is the MEAT. It's the most common one used. It's for monitor, evaluate, assess, or treat. So with the monitoring you know you're monitoring for signs and symptoms of a complaint. Sometimes they may refer the patient to a specialist because of a certain symptom. Evaluate is you know are they reviewing labs or other test results related to that condition? How are they responding to the treatment that's already in place? Assess are they ordering additional workup? Are they ordering additional labs? Maybe some a nuclear study an echocardiogram you know related to that condition they're addressing. How's the condition doing? Is it stable? Is it improving? Is it worsening? You know those types of details are important. And then as far as treatment too you know are they going to send the patient you know refer them for a procedure? Are they going to change the medication or refill current medications? Are they going to change the dose of the medications? Those types of details are needed when we're looking at our assessment and plan. The second term that is used is called TAMPER. So this one was created to assist coders when they're faced with a diagnosis listed as past medical history or when they are looking at a problem list as a way to help determine if those diagnoses should or shouldn't be submitted on your claim. Looking for evidence of treatment or simply ask yourself did the provider tamper with that condition listed? If the condition meets any one of these acronym words here like with the treatment assess, monitor, plan, evaluate, or referral then you can report it. Now remember your assessment and plan needs to be specific though when you're looking at leveling your service. So in a physician fee schedule world diagnoses are typically submitted when they have that meet acronym assigned to them. Typically we do anything that falls within the meet acronym in your assessment and plan. You're typically coding that. You're accounting for that condition in your overall leveling of your medical decision making. Those types of details because you have a lot more details here. With the TAMPER acronym sometimes you know they could be pulling from a problem list or you know previous conditions like maybe the patient has um maybe they had an amputation but it's not addressed in the assessment and plan but it's you know documented in their their problem list. The provider does talk about it in the H&P of the note. So those types of things is when you're you're going to apply the TAMPER. TAMPER was not created to be a competitor of that meet concept though. It was really made to help evaluate help coders evaluate whether or not you know conditions listed in the in the past medical histories should be reported whether they're active current ongoing conditions that may have symptoms. So again you're only going to apply your conditions in your assessment and plan that are supportive of being assessed and treated for your overall leveling. Now again don't confuse the two. So typically our meet acronym that's all of our assessment plan conditions that have with the status of the condition how it's treated all that those details and you'll use those for your leveling of your medical decision making. All right so how do you apply all this? Applying this concept so you are allowed to report all diagnosis codes that are current and addressed within that documented report. This does apply to your ICD-10-CM reporting though not your CPT. So again when you're determining your level of service you can only consider those conditions that were treated and addressed that would impact the complexity of that medical decision making. The assessment and plan should describe the status of each condition listed and you know how it's being treated what the plan is and it's again it's not simply enough to just list the conditions not comment on them and still report them on your claim. If it's truly not commented on it wasn't addressed and you shouldn't be reporting it. All right so this brings us to our Q&A so I'm going to pull up the Q&A document here and remember anything that I can't get through today or if there's something that has further specificity that I maybe need to research then I'll type that up in a document. So one question here I got is please explain the difference between AFib and AFlutter. Again this would be a great question to ask your provider and have them explain the conditions in more detail. It has to do based with off the the speed of the arrhythmia though and the location so again I highly encourage all of you to talk to your providers. It really helps build that relationship with them. Jolene and I did a podcast a couple years ago on this topic itself. It's so important to build that provider relationship you know with your provider. It does create trust they come to you when they have questions you can go to them. I learned a lot about cath lab coding specifically just from talking with the interventional cardiologists that I worked with. So again communicate with them it's the best thing you can do. Okay let's see what else we got. Does exacerbation heart failure equal acute on chronic? Again that's up to your provider to document that level of acuity. You shouldn't just assume it without them being specific to that. Let's see what if you are doing a pre-op cath and find CAD? Do you not code the I2510 as primary? Doesn't that trump the Z01810? So sometimes you we do see these the pre-op caths done maybe for a patient being evaluated for a TAVR procedure. If the cath is truly being done for pre-operative assessment of that TAVR, I would recommend coding the Z code first. Your I350 for your aortic stenosis and then your findings of your cath would be your I2510 you know as your additional. That would be my recommendation. Again if you're reporting that Z code on your claim and it's not listed first it's very likely your carrier will deny it. Second question was related to the same thing with the TAVR. Let's see can you show how you got to the new code file on the CDC site? Yes so from the link let me get back there. All right let me click on you. All right so we got the file open so you can see there's all these different links. So this is everything they've released from the CDC with the updates. So the file that I go to is the addenda file and this is the one and you can see there's different there's different links within each file too. So I believe it's this one. Then it'll open. Yeah and then it's going to give you different you know options to click on here. So there's multiple different files and links to click on so don't be scared to click on all of them because I know I do it too. And sometimes you know like the guidelines aren't always released right away so sometimes they may come later like you can see here it was released in July later in July. So again just don't be scared to click on stuff but yeah just you can either go to the CDC website or you go to CMS's website because they will also list what the CDC has released. All right. If the patient has right ventricular CHF and associated systolic heart failure is it assumed that the historic systolic heart failure is left ventricular? Yes that would be correct. So you would report your right and your left your systolic. Let's see provider documents the left anterior descending vessel with a 45% stenosis. The left circumflex 60% stenosis. Is this enough to assign a CAD diagnosis? Yes that is correct. If you have degrees of stenosis documented for the vessels you can code the I-25 series depending on the level of detail you have. Can you share the CEU link or so your CEU certificate will be posted to your MedAxium Academy account. We do ask that you give us you know anywhere from one to five business days to get that uploaded. Our team is very quick so I would say it's more on the the shorter end of the deal there. It should be there tomorrow or Monday. If you don't see there tomorrow just check again Monday and they should have your certificate uploaded. So if you don't see it and they should have your certificate uploaded you do have to log into your individual account though to access your CEU certificate. Is sinus bradycardia the same as six sinus syndrome diagnosis I-495? So sinus bradycardia is unspecified until they further specify the type of bradycardia. So it would not be the same unless your provider documents the patient has that sinus bradycardia due to the six sinus syndrome. It really would be up to your provider to document that level of detail. If my provider states non-rheumatic aortic and non-rheumatic mitral disease is there a combination non-rheumatic code? No there is not a combination non-rheumatic code. So you would code those individually under the non-rheumatic series. Your mitral valve goes to I-34 series and your aortic valve goes to the I-35 series. Let's see I'll take one more question and the rest we will answer and put in that Q&A document. So patient has had a stroke but has not fully recovered. So how do you code that? It's going to depend on the level of detail you have in your note. So if they've had the stroke they haven't fully recovered they have some residual effects you're going to be looking at your I-69 series just depending on the level of specificity. There are a lot of different codes to choose from in that I-69 series so it's really just going to depend on the level of detail that your provider has documented. If you don't have a lot of detail documented it may just map you to the unspecified I-69 or the I-639. So again it's just going to depend what you have documented in your note. All right well we are at the 2.30 time slot. So again I will answer all questions. Again we will put that Q&A document on our website. Next week is month end so I will try to get it up there before the end of the week but it may be the early part of October. But I do thank you for your time today. I hope you got some good information out of this presentation. I know just with me putting it together I learned some stuff. So I hope you enjoy your day and we will have another webcast we'll be announcing soon for our revenue cycle team that will have CEUs associated with it. So look forward to seeing everybody next time. Thank you.

fiscal year 2024

ICD-10-CM coding changes

cardiovascular conditions

Chapter 9

new codes

revisions

deletions

preoperative clearance

valve disease

acute myocardial infarctions

coding tips

Z01.810

primary diagnosis