The ICD-10 category I30-I52 covers a wide range of other forms of heart disease, including acute pericarditis, other diseases of pericardium, acute and subacute endocarditis, diseases of endocardium, myocarditis, cardiomyopathy, heart failure, and complications and ill-defined descriptions of heart disease.

Key Usage Points:

•Always code to the highest level of specificity.
•Use additional code, where applicable, to identify exposure to environmental tobacco smoke, history of tobacco use, or occupational exposure to environmental tobacco smoke.
•For patients with acute coronary syndrome, codes from category I21 should be sequenced first.
•In cases of heart failure and hypertension, code I11.0 should be used.
•When coding for heart failure, specify the type (systolic, diastolic, combined) if known.

Coding Guidelines

When to Use:

✓When a patient is diagnosed with acute pericarditis.
✓When a patient is suffering from diseases of endocardium.
✓When a patient is diagnosed with cardiomyopathy.
✓When a patient is suffering from heart failure.
✓When a patient has complications and ill-defined descriptions of heart disease.

When NOT to Use:

✗When a patient is diagnosed with a specific type of heart disease not covered in this range.
✗When the patient's condition is related to hypertension.
✗When the patient's condition is related to ischemic heart diseases.
✗When the patient's condition is related to cerebrovascular diseases.
✗When the patient's condition is related to diseases of arteries, arterioles, and capillaries.

Code Exclusions

Always verify exclusions with the patient's medical record and the latest version of the ICD-10-CM.

Documentation Requirements

Proper documentation is crucial for accurate coding. The medical record should include a clear and specific diagnosis, details of the patient's condition, and any related complications or manifestations.

Clinical Information:

•Specific type of heart disease.
•Details of any related complications or manifestations.
•Information on the patient's tobacco use or exposure.
•Type of heart failure, if applicable.
•Details of any surgical procedures performed.

Supporting Evidence:

•Medical history and physical examination findings.
•Results of any laboratory tests or imaging studies.
•Notes from any consultations or referrals.
•Medication records.

Good Documentation Example:

Patient diagnosed with dilated cardiomyopathy. Patient has a history of tobacco use. Echocardiogram shows dilated left ventricle with reduced ejection fraction.

Poor Documentation Example:

Patient has heart disease.

Common Documentation Errors:

⚠Not specifying the type of heart disease.
⚠Not documenting related complications or manifestations.
⚠Not including information on the patient's tobacco use or exposure.
⚠Not specifying the type of heart failure, if applicable.

Range Statistics

Total Codes

135

Billable

Complexity:

Medium

Primary Use:Clinical Documentation

Chapter:9

Coding Complexity

Medium

Complexity Rating

Coding for other forms of heart disease can be complex due to the need to code to the highest level of specificity and to identify related complications or manifestations. Additionally, coders need to understand the various forms of heart disease and their causes, and to code for tobacco use or exposure, if applicable.

Key Factors:

▸The need to code to the highest level of specificity.
▸The need to identify related complications or manifestations.
▸The need to code for tobacco use or exposure, if applicable.
▸The need to specify the type of heart failure, if applicable.
▸The need to understand the various forms of heart disease and their causes.

Specialty Focus

These codes are primarily used by cardiologists, but may also be used by internists, family practitioners, and other healthcare providers who manage patients with heart disease.

Primary Specialties:

Cardiology

70%

Internal Medicine

20%

Family Practice

10%

Clinical Scenarios:

• A patient presents with chest pain and is diagnosed with acute pericarditis.
• A patient with a history of rheumatic fever develops valvular heart disease.
• A patient with long-standing hypertension develops heart failure.
• A patient presents with palpitations and is diagnosed with atrial fibrillation.
• A patient with a history of alcohol abuse is diagnosed with alcoholic cardiomyopathy.

Resources & References

Several resources are available to assist with coding for other forms of heart disease.

Official Guidelines:

ICD-10-CM Official Guidelines for Coding and Reporting
American Heart Association Coding Guidelines
Centers for Medicare & Medicaid Services (CMS) ICD-10 Provider Resources

Clinical References:

American Heart Association Clinical Guidelines
American College of Cardiology Clinical Guidelines

Educational Materials:

American Academy of Professional Coders (AAPC) ICD-10 Training
American Health Information Management Association (AHIMA) ICD-10 Training

Frequently Asked Questions

What is the code for acute pericarditis?

The code for acute pericarditis is I30.

How do I code for a patient with heart failure and hypertension?

Use code I11.0 for hypertensive heart disease with heart failure.

What is the code for alcoholic cardiomyopathy?

The code for alcoholic cardiomyopathy is I42.6.