1. 12.3 ICD Chapter-Specific Guidelines and Format for the Circulatory System The most common cardiovascular system problems are chest pain, hypertension (HTN), edema, murmur, palpitations, congestive heart failure (CHF), arrhythmias, syncope, hyperlipidemia, claudication, and rheumatic heart disease – ICD-9-CM: Diseases of the Circulatory System is Chapter 7 (code range 390–459) – ICD-10-CM: Diseases of the Circulatory System is Chapter 9 (code range I00–I99) 12-13

2. 12.3 ICD Chapter-Specific Guidelines and Format for the Circulatory System (continued) Acute Rheumatic Fever ICD-9-CM: (390–392) or ICD-10-CM: (I00–I02) – Rheumatic fever without mention of heart involvement is ICD-9- CM: category 390, (ICD-10-CM: I00) – Rheumatic fever with mention of heart involvement is ICD-9- CM: category 391, (ICD-10-CM: I01)—codes in this category are further defined by the type of heart involvement: Acute rheumatic pericarditis (sudden, severe inflammation of the lining of the heart) Acute rheumatic endocarditis (sudden, severe inflammation of the inner cavities and chambers of the heart) Acute rheumatic myocarditis (sudden, severe inflammation of the heart muscles) – Rheumatic chorea with and without heart involvement is ICD-9- CM: category 392, (ICD-10-CM: I02) 12-14

3. 12.3 ICD Chapter-Specific Guidelines and Format for the Circulatory System (continued) Chronic Rheumatic Heart Disease ICD-9-CM: (393–398) or ICD-10-CM: (I05–I09) – Questions a coder must be able to answer: Which valve or valves were involved? – Mitral valve only – Aortic valve only – Mitral and aortic valves – Tricuspid valve What is the diagnosed disease of the valve or valves? – Stenosis only – Insufficiency only (could be documented as incompetence or regurgitation) – Stenosis with insufficiency 12-15

4. 12.3 ICD Chapter-Specific Guidelines and Format for the Circulatory System (continued) Hypertensive Disease ICD-9-CM: (401–405) or ICD-10-CM: (I10–I15) – Hypertension is a cardiovascular disease identified by increased pressure of arterial blood flow – ICD categorizes hypertension as benign or malignant – Benign hypertension is classified as arterial pressure that is mildly elevated – In malignant hypertension, the arterial blood pressure is very high – This severely elevated pressure may lead to necrosis of organs such as the eyes, heart, and kidneys – Malignant hypertension over time may also cause hemorrhage of vessels, which can lead to death 12-16

5. 12.3 ICD Chapter-Specific Guidelines and Format for the Circulatory System (continued) Hypertensive Disease ICD-9-CM: (401–405) or ICD-10-CM: (I10–I15) (cont.): – Hypertensive Heart and/or Kidney Disease is ICD- 9-CM: category 402–404 (ICD-10-CM: I11–I13) Hypertensive heart and hypertensive kidney disease are common complications of hypertension When reporting hypertensive heart disease, coders must use an additional code(s) to identify the type of heart disease and heart failure, when present When reporting hypertensive chronic kidney disease coders must use additional code(s) to identify the stage of kidney failure 12-17

6. 12.3 ICD Chapter-Specific Guidelines and Format for the Circulatory System (continued) Ischemic Heart Disease ICD-9-CM: (410–414) or ICD-10-CM: (I20–I25) – Occurs when blood supply to the heart is inadequate – Often caused by blockage or occlusion of a blood vessel – Acute Myocardial Infarction is ICD-9-CM: category 410, (ICD-10- CM: I21–I22) – Other Acute and Subacute Forms of Ischemic Heart Disease is ICD-9-CM: category 411 (ICD-10-CM: I20) – Angina pectoris is ICD-9-CM: category 413, (ICD-10-CM: I20 and I25) – Other Forms of Chronic Ischemic Heart Disease is ICD-9-CM: category 414, (ICD-10-CM: I25) 12-18

7. 12.3 ICD Chapter-Specific Guidelines and Format for the Circulatory System (continued) ICD-9-CM: Diseases of Pulmonary Circulation (415–417) or ICD-10-CM: Pulmonary Heart Disease and Diseases of Pulmonary Circulation (I26–I28): – Pulmonary circulation is the circulation between the heart and lungs – Conditions classified in this category affect both the lungs and heart – Pulmonary embolism with infarction is included and involves closure of the pulmonary artery due to a blood clot and infarction or necrosis (death) of lung tissue – Chronic pulmonary heart diseases are also included and are reported when the patient has long-term conditions relating to both heart and lungs 12-19

8. 12.3 ICD Chapter-Specific Guidelines and Format for the Circulatory System (continued) Other Forms of Heart Disease ICD-9-CM: (420–429) or ICD-10- CM: (I30–I52) – Diseases of the Pericardium, Endocardium, and Myocardium is ICD-9-CM: category 420–423 (ICD-10-CM : I30–I41) – Mitral, Aortic, Tricuspid, and Pulmonary Valve Disorders Not Specified as Rheumatic is ICD-9-CM: category 423 (ICD-10-CM : I34–I39) – Conduction Disorders is ICD-9-CM: category 426 (ICD-10-CM : I44–I45) – Cardiac dysrhythmias is ICD-9-CM: category 427 (ICD-10-CM : I46–I49) – Heart Failure is ICD-9-CM: category 428 (ICD-10-CM : I50) 12-20

9. 12.3 ICD Chapter-Specific Guidelines and Format for the Circulatory System (continued) Cerebrovascular Disease ICD-9-CM: (430–438) or ICD-10-CM: (I60–I69) – Subarachnoid hemorrhage (bleeding in the space between the brain and the lining) and intracranial hemorrhage (bleeding within the brain) are reported using codes from these code ranges – Occlusion and stenosis of precerebral and cerebral arteries also occur in this code range – Late effects of cerebrovascular disease are reported and include aphasia, dysphasia, hemiplagia, and disturbances of vision 12-21

10. 12.3 ICD Chapter-Specific Guidelines and Format for the Circulatory System (continued) Diseases of Arteries, Arterioles, and Capillaries ICD-9-CM: (440–449) or ICD-10-CM: (I70–I79) – Atherosclerosis of the aorta and renal artery are reported by codes from these categories – Atherosclerosis of the extremities is included, and the codes for this condition are further defined by involvement of native arteries or bypass grafts – Aortic aneurysm and dissections are also reported, as well as aneurysms of the upper extremity, renal artery, iliac artery, and other lower extremity arteries 12-22

11. 12.3 ICD Chapter-Specific Guidelines and Format for the Circulatory System (continued) ICD-9-CM: Diseases of Veins and Lymphatics, and Other Diseases of Circulatory System (451–459) or ICD-10-CM: Diseases of Veins, Lymphatic Vessels, and Lymph Nodes, Not Elsewhere Classified (I80–I89) – Phlebitis and Thrombophlebitis is ICD-9-CM: category 451 (ICD- 10-CM : I80) – Varicose Veins of Lower Extremities is ICD-9-CM: category 454 (ICD-10-CM : I83) – Noninfectious Disorders of Lymphatic Channels is ICD-9-CM: category 457 (ICD-10-CM : I89) 12-23