3 ICD-10-CM Cardiology Coding Tips That Line Up With the Risk-Adjustment Trend

All the discussions of risk adjustment have put a spotlight on diagnosis coding, and one big way cardiology coders can help is by ensuring they follow the official rules for coding and learn about coding comorbidities, too. Here are some good, old-fashioned rules that will also help ensure your pro-fee cardiology coding follows best practices and is ready to support proper payment in the future.

1. Understand the Role of Comorbidities

For risk adjustment, a simplified explanation is that a patient’s health status and spending are considered in relation to outcomes and costs. So a patient with diagnosis X and significant comorbid conditions may yield higher reimbursement (because of higher expected costs of care) than a patient with the same diagnosis X but no comorbid conditions, assuming a risk-adjustment model is used.

In other words, including diagnosis codes for relevant comorbidities that the provider documents helps show the complexity of the case. For instance, if the cardiologist is treating a patient with congestive heart failure, you may see documentation that the doctor had to factor the patient’s COPD, anemia, or arthritis into the patient’s treatment. Experts advise that coding the comorbidities lets the payer know the additional conditions the patient has so the payer can better estimate (and not underestimate) the expected costs for the patient.

2. Don’t Overdo Symptom Coding

Don’t let the emphasis on related diagnoses lead you to report symptoms when you shouldn’t. The 2018 ICD-10-CM Official Guidelines for Coding and Reporting (Section I.B) instruct you:

  • If you’ve got a confirmed diagnosis, report that instead of a signs/symptoms code.
  • Don’t assign additional codes for signs/symptoms typically associated with a disease (unless there’s an instruction specific to that code that says otherwise).
  • You may report signs/symptoms not routinely associated with the disease process.

3. Look Out for Combo Codes and ‘Additional Code’ Notes

ICD-10-CM includes a lot of combination codes for cardiology conditions, so be sure you use them when appropriate to capture the patient’s conditions accurately. For example, compare what’s included in these two codes:

  • I11.0 (Hypertensive heart disease with heart failure)
  • I13.2 (Hypertensive heart and chronic kidney disease with heart failure and with stage 5 chronic kidney disease, or end stage renal disease).

While you’re at it, don’t forget to follow your code’s instructions to “code first,” “code also,” or “use additional code” to give the whole picture. Using our examples above, a note with I11.0 instructs you to “Use additional code to identify type of heart failure (I50.-),” so you should select the correct code from the I50.- category to complete your coding.

But, again, don’t be overzealous. You should report only those codes supported by the documentation. As the Official Guidelines have been clarified to say, “When there is a ‘code first’ note and an underlying condition is present, the underlying condition should be sequenced first, if known.” Don’t choose a code based on assumptions.

What About You?

Are you taking steps to ensure your ICD-10 coding skills are current? We should have our first look at 2019 ICD-10-CM codes soon, bringing new codes and guidelines to learn!

About 

Deborah works on a wide range of TCI SuperCoder projects, researching and writing about coding, as well as assisting with data updates and tool development for our online coding solutions. Since joining TCI in 2004, she’s covered the ins and outs of coding for radiology, cardiology, oncology and hematology, orthopedics, audiology, and more.

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