Other Circulatory System Diagnoses


MS-DRG	CMS DRG (Prior to 10/1/2007)
314	Other Circulatory System Diagnoses with MCC	144	Other Circulatory System Diagnoses with CC
315	Other Circulatory System Diagnoses with CC	145	Other Circulatory System Diagnoses without CC
316	Other Circulatory System Diagnoses without CC/MCC

Definition of Principal Diagnosis

The principal diagnosis is that condition established after study to be chiefly responsible for occasioning the admission of the patient to the hospital for care. Two or more diagnoses may equally meet the definition for principal diagnosis. This is in terms of the circumstances of admission, diagnostic work-up and/or therapy provided. Be aware that there is a difference between admitting a patient to treat two conditions and two conditions being present at the time of admission. The principal diagnosis is always the reason for admission

Coding Guidelines

Acquired septal defect due to a previous acute myocardial infarction (AMI) (less than eight weeks old)

This is coded 429.71, acquired cardiac septal defect, and 410.92, AMI, unspecified site, subsequent episode of care. (See Coding Clinic, third quarter 1989, pages 5 and 6.)

AMI/acute and chronic coronary insufficiency

These diagnoses only need the code for the AMI to be coded. Acute coronary insufficiency, coded 411.89, is not coded, since code 411.89 is not coded with a code from 410.XX. Chronic coronary insufficiency, coded 414.8, can be coded to show a current history of it for internal purposes, but it is not necessary. (See Coding Clinic, first quarter 1991, page 14, and Coding Clinic, November-December 1986, page 12.)

AMI/cardiac arrhythmias/conduction disorders

Paroxysmal supraventricular tachycardia, atrial flutter, atrial fibrillation, ventricular fibrillation, conduction disorders or complete AV block, Mobitz II AV block, second-degree AV block and Wenchebach's block should be coded as an additional code with an AMI if they occur and are treated. (See Journal of AHIMA, October 1992, pages 26 - 28.)

AMI/clinical information

AMI may be transmural, involving the full thickness of the ventricular wall or subendocardial (nontransmural) involving only the inner one third to one half or the ventricular wall. (See CodeWrite, May 1993 pages 6 - 8.)

AMI with extension

If a patient during the same admission has an AMI, and then an extension or reinfarction of the MI in the same site, only use one code for the site. If the MIs occur in two different sites during the same admission, use a code for each site. (See Coding Clinic, volume 10, number 5 1993, pages 13 and 14.)

Acute myocardial ischemia

Acute myocardial ischemia with an infarction is coded as an AMI, 410.XX. Acute myocardial ischemia without an infarction but with evidence of occlusion or thrombosis is coded 411.81. Acute myocardial ischemia without an infarction or evidence of occlusion or thrombosis is coded 411.89, other acute and subacute forms of ischemic heart disease. (See Coding Clinic, third quarter 1991, page 18.)

Admission for an AMI with transfer to another acute hospital

If a patient with an AMI is transferred for a heart catheterization and continues to receive treatment for the AMI, the principal diagnosis at the second hospital is the AMI. The AMI is coded with a fifth digit of "1" at the second hospital, because the patient was transferred. (See Coding Clinic, volume 10, number 5 1993, page 14, and Coding Clinic, fourth quarter 1992, page 24.)

Cardiac rehabilitation, outpatient, following an AMI

If encounter is solely for cardiac rehabilitation, code V57.89, care involving use of rehabilitation procedures, other, as the first listed diagnosis. Use additional code of 410.x2, AMI, subsequent episode of care, if encounter occurs within eight weeks post AMI code. Continue to use 410.x2 until sessions are completed even if it goes beyond the eight weeks post AMI. If the first rehabilitation encounter is begun after the eight week post AMI time frame, use code 412, old MI. (See Coding Clinic, third quarter 2001, page 21, and Coding Clinic, third quarter 1998, page15.)

Codes 425.7 and 425.8

Codes 425.7, nutritional and metabolic cardiomyopathy, and 425.8, cardiomyopathy in other diseases classify elsewhere, are italicized codes and therefore, should never be the principal diagnosis. The underlying disease is always listed first. ICD-9-CM coding convention.

Codes V42, V42.1, V42.2, V43.2, V43.3 and V43.4

These codes are only used if there are no complications or malfunctions of the organ or tissue replaced. Codes from category V42 are never used with codes from category 996.8, complications of transplanted organ. (See Coding Clinic, fourth quarter 1998, page 43; Coding Clinic, third quarter 1998, pages 3 and 4; and Coding Clinic, second quarter 1994, page 9.)

Complication of transplanted heart/congestive heart failure (CHF)

A patient with a history CHF prior to a heart transplant was admitted for CHF one year following the heart transplant. Since the CHF affected the transplant organ, this is considered a complication of the heart transplant, coded 996.83, with a secondary diagnosis of CHF, coded 428.0. (See Coding Clinic, third quarter 1998, page 5.)

Complications of transplanted organ (subcategory 996.8)

These codes are used for rejection of a transplanted organ and complications or diseases of the transplanted organ. When the function of the transplanted organ is affected, pre-existing conditions or post-transplant medical conditions are coded as complications of the transplanted organ; for example, a patient with a heart transplant was admitted for CHF. Because the heart was affected, this is coded 996.83, complications of transplanted organ, heart, plus the code 428.0, for the CHF. (See Coding Clinic, third quarter 1998, pages 3-5.)

Post-cardiac transplant patient admitted with nasopharyngeal Epstein-Barr virus lymphoproliferation is coded 238.7, neoplasm of uncertain behavior of other and unspecified sites and tissues, other, 075, infectious mononucleosis, and V42.1, organ or tissue replaced by transplant, heart. Code 996.83, complications of transplanted organ, heart, should only be assigned if the physician documents the transplanted heart has become affected by the Epstein-Barr lymphoproliferative disorder. (See Coding Clinic, third quarter 2001, pages 13-14.)

Congestive or dilated cardiomyopathy/CHF

Congestive cardiomyopathy is a myocardial disease characterized by ventricular dilation, contractile dysfunction and symptoms of CHF. When a patient is admitted with cardiomyopathy and CHF, and the treatment is directed towards the management of the CHF, the CHF, coded 428.0, should be the principal diagnosis with a secondary diagnosis of cardiomyopathy, coded 425.4. (See Coding Clinic, second quarter 1990, page 19.)

Coronary artery stent stenosis

Coronary artery stent stenosis is coded 996.72, other complication of internal (biological) (synthetic) prosthetic device, implant, and graft, due to other cardiac device, implant, and graft. (See Coding Clinic, third quarter 2001, page 20. This supercedes information published in Coding Clinic, first quarter 2000, page 10.)

Cytomegalovirus (CMV)/heart transplant

If a heart transplant patient has CMV from his transplanted heart, it is a complication of the transplanted heart. Code 996.83, complication of heart transplant, plus an additional code of 078.5, cytomegalic inclusion disease. (See Coding Clinic, fourth quarter 1993, page 29, and Coding Clinic, third quarter 1993, page 13.)

Dissection of coronary artery

Code 414.12, Dissection of coronary artery, was created 10/1/02. Arterial dissection is defined as blood coursing within the layers of the arterial wall. Arterial dissections are common complications of interventional procedures, such as cardiac catheterization or angioplasty. Spontaneous coronary artery dissection is rare. (See Coding Clinic, fourth quarter 2002, pages 54 and 55.)

Fifth digits of "0" and "2" for code 410.xx

A fifth digit of "0", episode of care unspecified, should be avoided. Physician clarification should be obtained.

A fifth digit of "2", subsequent episode of care, on a category 410 code is used following discharge for initial care of AMI to indicate further observation, evaluation or treatment was needed for a MI that is less than eight weeks old.

(See Coding Clinic, fourth quarter 1992, page 24, and Coding Clinic, third quarter 1989, pages 3 and 4.)

Hypertension/hypotension/complication of procedure

Malignant hypertension, which is a complication of a procedure, was coded 997.1 plus 401.0 prior to 10/1/95. Since the creation of code 997.91 (10/1/95), this is coded 997.91. (See ICD-9-CM 10/1/95 revisions and Coding Clinic, fourth quarter 1993, pages 3, 41 and 42.)

Hypotension, which is a complication of a procedure, was coded 997.1 plus 458.9 prior to 10/1/95. Since the creation of code 458.2 (10/1/95), this is coded 458.2. (See ICD-9-CM 10/1/95 revisions and Coding Clinic, fourth quarter 1993, pages 41 and 42.)

Hypotension/AMI

Hypotension was considered integral to an AMI, so only the AMI was coded until 10/1/97, when the new code 458.8, other specified hypotension was created. A post MI hypotension should be coded with an AMI (410.x1 plus 458.8). (See Coding Clinic, fourth quarter 1997, page 37, and Coding Clinic, third quarter 1995, page 9.)

Increase of premature ventricular contractions (PVCs) due to surgery

This is coded 997.1, cardiac complications, and 427.69, PVCs, as an additional code to identify the cardiac complication. (See Coding Clinic, fourth quarter 1993, page 42 and 43.)

INOmax therapy

INOmax (nitric oxide/nitrogen) therapy is used to treat persistent pulmonary hypertension in newborns and pulmonary hypertension in patients with respiratory failure and hypoxia. This was coded 93.98, other control of atmospheric pressure and composition, until 10/1/02 when a new code was created. This is now coded 00.12, administration of inhaled nitric oxide. (See Coding Clinic, fourth quarter 2002, page 94, and Coding Clinic, first quarter 2002, page 14.)

Ischemic cardiomyopathy

This is coded 414.8, other specified forms of chronic ischemic heart disease, unless documentation substantiates use of one of the other ischemic heart disease codes, 410-414. (See Coding Clinic, second quarter 1990, page 19.)

Mechanical complication of cardiac device, implant and graft, due to coronary bypass graft (996.03)

As of 10/1/94, code 996.03, mechanical complication of cardiac device, implant and graft, due to coronary bypass graft, excludes atherosclerosis of graft (414.02 and 414.03) and embolism (occlusion NOS) thrombosis of graft (996.72).

Code 996.03 does include occlusion of coronary bypass graft (live or synthetic) due to:

Failure of the live graft to maintain patency (graft closure during first year) (early graft failure) excluding that due to progression of atherosclerosis or thrombosis.
Fibrointimal proliferation (hyperplasia). This is a process distinct from atherosclerotic process.
Hyperplasia, internal of live graft (late graft closure).

(See Coding Clinic, November-December 1986, pages 5 and 6.)

Mural thrombus 12 weeks post AMI

This is coded 429.79, other certain sequelae of MI, NEC, for the mural thrombus and 414.8, other specified forms of chronic ischemic heart disease, for the MI over eight weeks old. (See Coding Clinic, third quarter 1989, pages 5 and 6.)

Pacemaker evaluation by telephone

This is coded V53.31, fitting and adjustment of other device, cardiac device, cardiac pacemaker and 89.45, artificial pacemaker, rate check. (See Coding Clinic, first quarter 2002, page 3.)

Postoperative complication of cardiac arrest

When cardiac arrest occurs as a postoperative complication, code 997.1, complications affecting specified body systems, not elsewhere classified, cardiac complications, and code 427.5, cardiac arrest. Code 427.5 is also used because the nature of the complication is not specified in codes in category 997, complications affecting specific body systems, not elsewhere classified. (See Coding Clinic, second quarter 2000, page 12.)

Progressive coronary artery disease (CAD) of post heart transplant

Progressive CAD of the transplanted heart is coded 414.0X plus an additional code of V42.1, organ or tissue replaced by transplant - heart. (See Coding Clinic, second quarter 1994 page 13.)

Replacement of pacemaker pulse generator (battery)

If the battery is demonstrating no problems, but is replaced because it is soon due to expire, use only the diagnosis code V53.31 (V53.3 prior to 10/1/94), fitting and adjustment of cardiac pacemaker to code the replacement. (See Coding Clinic, third quarter 1992, page 3.)

Septicemia due to a vascular access device

First code 996.62, the infection and inflammatory reaction due to other vascular device, implant and graft, and then the septicemia code from category 038. (See Coding Clinic, second quarter 1994, page 13.)

Subsequent episode of care for an AMI/congestive heart failure (CHF)

A patient was admitted for CHF one week following an admission for an AMI. The principal diagnosis is CHF, coded 428.0, because it was the reason for admission and treatment, and AMI, subsequent episode of care, coded 410.92, is a secondary diagnosis. (See Coding Clinic, third quarter 1997, page 10.)

Transplant rejection/heart

Patient had had a heart transplant for idiopathic cardiomyopathy. A cardiac catheterization with heart biopsy was done. If physician identifies rejection, code 996.83, complication of transplanted organ, heart, as reason for visit and 37.25, biopsy of heart, for the procedure. If rejection is not identified, code V67.09, follow-up examination, following other surgery, as reason for visit, V42.1, organ or tissue replaced by transplant, heart as an additional diagnosis and 37.25 for the procedure. (See Coding Clinic, third quarter 2003, page 16.

Unstable angina/AMI/cardiac catheterization

If a patient is admitted with unstable angina and has an AMI during a cardiac catheterization and the physician states the AMI was due to the procedure, the principal diagnosis is unstable angina (411.1), when no cause of the unstable angina has been determined, with additional codes for complication of the procedure (997.1) and the AMI (410.xx).

If a patient is admitted with unstable angina and five days later had an AMI, only a code for the AMI (410.xx) is needed.

(See Coding Clinic, fourth quarter 1993, pages 39 and 40.)

Long Term Care Hospitals

Admission for continued treatment of infected AV graft

A chronic renal failure patient was transferred from an acute care hospital to a long term care hospital (LTCH) following removal of an infected AV graft in her left arm. Patient was transferred to continue antibiotic therapy and hemodialysis via Quinton catheter. The principal diagnosis for the LTCH stay is the infected AV graft, coded 996.62, infection and inflammatory reaction due to internal prosthetic device, implant, and graft, due to vascular device implant, and graft. (See Coding Clinic, fourth quarter 2003, pages 111 and 112.)