ICD-9: Make Valve Coding an Open-and-Shut Case

Common valve disorders, often called heart murmurs because of the distinctive sound the patient's heart makes, include stenosis (a narrowing of the valve that interferes with the valve opening) and insufficiency or regurgitation (a problem that results when the valve doesn't close completely).

When coding valve disorders, you should be sure to first check the index of your ICD-9 manual and then read the code descriptions for guidance, including references to other codes, says Bruce Rappoport, MD, CPC, a board-certified internist who works with physicians on compliance, documentation, coding and quality issues for RCH Healthcare Advisors LLC, a Fort Lauderdale, Fla.-based healthcare consulting company.

The subtext under the headings is very important in coding valve disease" " Rappoport says. "It will tell you what is included in and excluded from the code."

Find the Correct Series

The first step in coding a valve disorder is to determine the problem's origin because that determines which ICD-9 series you use.

"Coders often forget that there are three different code series " Rappoport says.

Use the 393-398 series (Chronic rheumatic heart disease) if the defect resulted from rheumatic fever an inflammatory disease that begins with a strep throat infection and can cause heart complications. When using these codes "make certain that the word 'rheumatic' is stated in the documentation " says Marti Geron CPC CMA CM reimbursement manager at the University of Texas Southwestern Medical Center at Dallas.

That said this rule has an important and confusing variant. Although the ICD-9 manual describes the 393-398 series as being for "chronic rheumatic heart disease " it specifies that you should use 396.x (Diseases of mitral and aortic valves) when the patient has problems with both the mitral and aortic valves "whether specified as rheumatic or not." This may be because physicians once believed that multiple valve problems were predominantly rheumatic in nature Rappoport says. But today doctors do see multiple valve problems from other causes. (See more detail on coding multiple valve problems below.)

The other two code series used most often for valve disorders are more straightforward. Use the 746.x series (Other congenital anomalies of heart) if the valve problem is congenital or dates from birth. Use the 424.x series (Other diseases of endocardium) for heart valve disorders resulting from other causes such as infection.

Specify the Valve and the Problem

After you select the code series you should next determine which valve is diseased and what the specific defect is. Remember as stated above that if more than one valve is involved you will not code each valve disorder separately Rappoport says.

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Related Articles - Internal Medicine codes, Valve Coding, Open-and-Shut Case, medical coding, medical billing, icd-9 codes, cpt codes, hcpcs codes,

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