How to Conquer the Challenges of Teaching Cardiovascular Medical Coding

Stethoscope laying on a computer keyboard

As the aging population in America continues to grow, the need for health care and professional medical coders will continue to increase significantly.  The scope and complexity of the transition to ICD-10-CM/PCS by healthcare providers in the United States is significant. The conversion to a modified version of the classification system already in use by the rest of the world will be a transformational effort in the U.S. affecting many systems, processes, and people. It will have a tremendous and widespread impact on every operational process across healthcare. Employers desire a well-trained workforce to ensure accuracy and to maximize revenue. ICD-10 CM/PCS implementation is generating a flurry of excitement in conjunction with an overall uneasiness about how prepare and adapt to the new system. This post is the second in a series from industry expert and award-winning author, Lorraine Papazian-Boyce, on some of the most complex medical specialties.  To learn more from Lorraine Papazian-Boyce, sign up for one of her upcoming webinars here!

Cardiovascular coding is challenging because of the need for detailed anatomical specificity both in the documentation and codes, the common existence of multiple comorbidities, and the frequent use of mechanical devices. Some students might not recall or have been exposed to all the anatomical and pathology information needed. The task of instructors is multiplied when all codes sets—ICD-10-CM, ICD-10-PCS, ICD-9-CM, and CPT— are considered. There is little overlap among the coding guidelines and the guidelines are sometimes opposite for various code sets.

Challenges in diagnostic coding (ICD-10-CM, ICD-9-CM) include:

  • ICD-10-CM terminology has been updated from that in ICD-9-CM for angina pectoris, myocardial infarction, atherosclerosis, pulmonary embolism, cardiac arrest, and nontraumatic subarachnoid hemorrhage to be consistent with current clinical practice.
  • Cardiovascular history, such as past myocardial infarctions, can affect coding for the current encounter.

Challenges in procedure coding include:

  • Bundled or packaged services must be identified.
  • The anatomy and location of specific vessels and vessel families or branches must be identified.

Accurate cardiovascular coding requires a consistent, methodical approach which I develop using the three skills of an “Ace coder:” abstracting, assigning, and arranging (sequencing) codes. When abstracting, students review the medical record with a list of questions specific to cardiovascular diagnoses and procedures. They must answer these questions before they begin coding the case. Examples of abstracting questions when coding ICD-10-CM are:

  • Does the patient have a current, subsequent, or old MI?
  • If a vessel is blocked or diseased, is it an artery or vein? Is it a native or grafted vessel?
  • Does the patient use anticoagulants or antithrombotics on a long-term basis?

CPT requires separate abstracting questions for general cardiac procedures, coronary artery bypass grafting, venous access procedures, pacemaker procedures, and vascular procedures. Examples are:

  • Was imaging supervision and interpretation provided by the surgeon?
  • How many distal anastomoses are performed in a coronary artery bypass graft procedure?
  • Is a catheter for a central venous access procedure inserted centrally or peripherally and, if centrally, is it tunneled or nontunneled?

ICD-10-PCS abstracting focuses on identifying the correct root operation.

Examples are:

  • Did the procedure involve an external device left in place in, on, or in replacement of a body part?
  • Did the procedure alter the diameter or route of a tubular body part?

Assigning codes involves using the Index and Tabular List to identify the code(s) for each condition or procedure, assigning all characters of the code, and following official guidelines and instructional notes in the coding manual. Diagnosis coding for cardiovascular requires close attention to instructional notes in the Tabular List regarding additional codes are required to identify related conditions and lifestyle habits related to tobacco use. Coders must identify whether the relationship between hypertension and comorbidities is causal or non-causal for proper coding. CPT provides special instructions at the beginning of the cardiovascular subsection about how to code for catheterization within a vascular family. The Tabular List provides extensive instructions regarding coding for the insertion or revision of pacemakers and implantable cardiac defibrillators. When assigning ICD-10-PCS codes for coronary artery bypass, coders must give special attention to the official guidelines, which define the correct use of characters 4 and 7 of the bypass code.

Arranging (sequencing) codes involves again following official guidelines and instructional notes to place the codes in the correct sequence. ICD-10-CM Official Guidelines for Coding and Reporting provide guidance regarding the sequencing when a myocardial infarction is involved. When multiple inpatient procedures are performed, ICD-10-PCS requires sequencing the procedure most related to the principal diagnosis as the principal procedure, regardless of the price of the procedures or the order in which they were performed.

To help you better understand how to apply these principles to cardiovascular coding, Pearson is hosting a complimentary webinar, Teaching Cardiovascular Across Code Sets: ICD-9-CM, ICD-10-CM, ICD-10-PCS, CPT on Wednesday, October 21, 2015 1:00PM – 2:30 PM Eastern Time. We will take a sample cardiovascular case and code it in all code sets: ICD-10-CM/PCS, ICD-9-CM, and CPT. AHIMA and AAPC CEUs are offered. Click here to register!  

Registration is required and free.

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About the Author
Lorraine M. Papazian-Boyce, MS, CPC

Lorraine M. Papazian-Boyce, MS, CPC

Lorraine M. Papazian-Boyce is an award-winning author and instructor. She has authored two Pearson titles, ICD-10-CM/PCS Coding: A Map for Success, which received the Most Promising New Textbook Award–2013 from the Textbook and Academic Authors Association. Her newest title, Pearson’s Comprehensive Medical Coding is receiving rave reviews–students and instructors alike value her approach and simplified methodology of abstracting, assigning, and arranging code sets. She was named Educator of the Year – Instruction – 2011 by Career Education Corporation (CEC). Lorraine also contributed to the development of Pearson’s online, comprehensive coding solution, MyHealthProfessionsLab for Medical Billing & Coding. This new solution can be used across your entire coding program and covers content from all code sets.
Lorraine has taught at several career colleges, both traditional and online. She has over 30 years of experience in healthcare administration as office manager; biller and coder; management consultant to hospitals, nursing homes, and physicians; and former owner of a medical billing and coding service. Lorraine has contributed to numerous textbooks and journals in the health professions field and is a nationally-known speaker. She holds a M.S. in Health Systems Management; the CPC credential; and is an AHIMA-Approved ICD-10-CM/PCS Trainer and Ambassador.