Questions/Answers for ICD-10-CM Coding: Chapter 9 - Diseases of the Circulatory System

1.    Elevated blood pressure

Correct answer: R03.0

2.    According to ICD-10-CM guidelines, what is the maximum length of time for a myocardial infarction to be considered acute?

Correct answer: 4 Weeks

3.    Acute myocardial infarction

Correct answer: I21.9

4.    Coronary artery disease (CAD)

Correct answer: I25.10

5.    A patient presents to the ED with hemiparesis on the left side and aphasia. The patient is admitted to the hospital and found to have a cerebrovascular accident (CVA). Patient has physical therapy and speech therapy while in the hospital to address the hemiparesis and aphasia. He is left handed. What ICD-10-CM code(s) are reported?

Correct answers: R47.01, G81.92, I63.9

6.    CAD of coronary bypass graft with angina. The patient had a CABG 2 years ago. What diagnosis code(s) is reported?

Correct answer: I25.709 (You would not code Z95.1 See I.C.21.C.3 Guideline: A status code should not be used with a diagnosis code from one of the body system chapters, if the diagnosis code includes the information provided by the status code. I25.709 already represents that patient has had a CABG.

7.    A patient has end-stage renal disease and hypertension. What ICD-10-CM code(s) are reported.

Correct answers: I12.0, N18.6

8.    A patient is admitted to the hospital for end-stage renal disease and hypertension. What is the principal diagnosis code?

Correct answer: I12.0

9.    Hypertension and congestive heart failure. What are the ICD-10-CM diagnosis codes?

Correct answer: I11.0, I50.9

10.Hypertension and acute diastolic heart failure and chronic kidney disease state 3. What are the ICD-10-CM diagnosis codes?

Correct answers: I13.0, I50.31, N18.30

11.The patient is admitted for acute diastolic heart failure. He also has hypertension and stage 3 chronic kidney disease. What is the principal diagnosis code?

Correct answer: I13.0

12.A patient is admitted for management of malignant hypertension. He also has stage 5 CKD and myocardial disease. At discharge, the provider documents the myocardial disease is unrelated to the hypertension. What ICD-10-CM codes are reported?

Correct answers: I12.0, N18.5, I51.5

13.A patient is admitted for management of malignant hypertension. He also has stage 5 CKD and myocardial disease. At discharge, the provider documents the myocardial disease is unrelated to the hypertension. What ICD-10-CM code is the principal diagnosis?

Correct answer: I12.0

14.True or False? if STEMI converts to NSTEMI due to thrombolytic therapy, it is still coded as NSTEMI.

Correct answer: False

15.The patient was admitted and given thrombolytic therapy for an acute myocardial infarction (STEMI) of the anterolateral wall, which then converted to a NSTEMI. What ICD-10-CM code is reported?

Correct answer: I21.09

16.A patient is admitted for cerebral infarction due to occlusion of the left middle cerebral artery. The patient had left-sided hemiplegia and aphasia from a previous CVA. The patient is right handed. What ICD-10-CM codes are reported?

Correct answers: I63.512, I69.320, I69.354

17.Patient is admitted for malignant hypertension. He also has cardiomegaly. Provider documents cardiomegaly is not due to the hypertension. What are the ICD-10-CM codes reported?

Correct answers: I10, I51.7

18.The patient is admitted for acute on chronic diastolic heart failure and hypertension. He also has a history of a nontraumatic intracranial hemorrhage with residual right sided hemiplegia. The provider documents that the heart failure and hypertension are unrelated. What ICD-10-CM codes are reported?

Correct answers: I50.33, I10, I69.151

19.What is the correct diagnosis coding for a 41-year-old male patient with coronary artery dis-ease (CAD) with angina? This patient has no previous history of coronary artery bypass grafting (CABG).

Correct answer: I25.119

20. 71-year-old female is being treated in the hospital for an acute non-ST myocardial infarction that she suffered 4 days ago. She also has atrial fibrillation.Correct answers: I21.4, I48.91

21. A patient who suffered an acute non-ST elevation myocardial infarction 3 weeks ago, presents to the emergency department and is now diagnosed with a new ST-Elevation (STEMI) myocardial infarction involving the inferior wall. She is still being monitored following her initial heart attack 3 weeks earlier and continues to have atrial fibrillation. She will be transferred to a larger facility for cardiac catheterization and possible further intervention. What ICD-10-CM codes are reported?

Correct answers: I48.91, I21.19, I22.2

Chapter 9 Answers with Rationales

Question 1

Rationale:

ICD-10-CM Alphabetic Index: Elevated, elevation > blood pressure > reading (incidental) (isolated) (nonspecific), no diagnosis of hypertension > R03.0. The code is confirmed in the Tabular List.

ICD-10-CM guideline I.C.9.a.7 tells us to assign code R03.0 Elevated blood pressure reading without diagnosis of hypertension unless the patient has an established diagnosis of hypertension.

Question 2

Rationale: ICD-10-CM guideline I.C.9.e.1, myocardial infarctions are classified as acute if the duration is four weeks (28 days) or less from onset. In the Tabular List the Includes note also lists this under category code I21.

Question 3

Rationale: ICD-10-CM Alphabetic Index: Infarct, infarction > Myocardium, myocardial (acute) (with stated duration of 4 weeks or less) > I21.9. Verify code selection in the Tabular List.

Question 4

Rationale: ICD-10-CM Alphabetic Index look for Disease > Coronary (artery) > “see” Disease > Heart > Ischemic > Atherosclerotic.

Disease > Heart > Ischemic > Atherosclerotic (of) > I25.10. Verify code selection in the Tabular List.

A patient with CAD and no mention of a history of a previous CABG indicates it would be the patient’s native coronary artery (it has not been replaced or bypassed).

Question 5

Rationale: In the ICD-10-CM Alphabetic Index, look for Accident > Cerebrovascular (embolic) (ischemic) (thrombotic) > I63.9. A CVA is also known as a stroke. Verify code selection in the Tabular List.

Report the hemiparesis and the aphasia also since they were both evaluated and treated during the stay. 

Question 6

Rationale: ICD-10-C ICD-10-CM Alphabetic Index: Disease > artery > coronary > with > angina pectoris > “see” Arteriosclerosis, coronary (artery). Arteriosclerosis, arteriosclerotic > coronary (artery) > bypass graft > with > angina pectoris > I25.709.

The patient is also status post CABG.

ICD-10-CM ICD-10-CM Alphabetic Index: Status > aortocoronary bypass > Z95.1. Verify code selection in the Tabular List. CAD is an abbreviation for coronary artery disease. CABG is an abbreviation for coronary artery bypass graft.

Question 7/8

Rationale:

ICD-10-CM Alphabetic Index: Hypertension, hypertensive > With > Kidney involvement > “see” Hypertension > Kidney. Hypertension > Kidney > With > Stage 5 chronic kidney disease (CKD) or end stage renal disease (ESRD) > I12.0.

In the Tabular List there is an instructional note to use an additional code to identify the stage of the chronic kidney disease (N18.5, N18.6).

In this case the patient has end stage renal disease, reporting code N18.6.

ICD-10-CM Alphabetic Index: Disease, diseased > Renal > With > End stage (failure) > N18.6. Verify code selection in the Tabular List.

ICD-10-CM guideline I.C.9.a.2 indicates to assign codes from category I12 when conditions classified to category N18 are present with hypertension. A causal relationship is assumed between hypertension and chronic kidney disease.

Guideline I.C.14.a.1 tells us to code N18.6 when the provider has documented end stage renal disease.

Question 9

Rationale:

ICD-10-CM Alphabetic Index: Hypertension, hypertensive > heart > with > heart failure (congestive) I11.0. Verify the code in the Tabular List. There is an instructional note under code I11.0 that tells us to use an additional code to identify the type of heart failure (ICD-10-CM guideline I.C.9.a.1). The additional code is sequenced second.

The patient has congestive heart failure.

ICD-10-CM Alphabetic Index: Failure > Heart > Congestive > I50.9. Verify the code in the Tabular List. Under code section I50 there is an instructional note telling us to code first heart failure due to hypertension. This confirms our sequencing.

According to ICD-10-CM guideline I.C.9.a, there is a presumed causal relationship between hypertension and heart involvement. In this case, the patient has hypertension and congestive heart failure.

Question 10/11

Rationale:

ICD-10-CM Alphabetic Index: Hypertension, hypertensive > Heart > With > Kidney disease > “See” Hypertension > Cardiorenal. ICD-10-CM Alphabetic Index: Hypertension > Cardiorenal > With > Heart Failure > With Stage 1 through 4 Chronic Kidney Disease > I13.0.

Verify the code in the Tabular List. There are TWO instructional notes under code I13.0 that tells us to use an additional code to identify the type of heart failure) I50.- and the Stage of chronic kidney disease (N18.1-N18.4, N18.9)

(ICD-10-CM guideline I.C.9.a.1). The additional code is sequenced second.

The patient has Acute Diastolic Heart Failure:

ICD-10-CM Alphabetic Index: Failure > Heart > Diastolic > Acute > I50.31. Verify the code in the Tabular List. Under code section I50 there is an instructional note telling us to code first Heart Failure due to Hypertension with Chronic Kidney Disease (I13-). 

This confirms our sequencing.

The patient has Stage 3 Chronic Kidney Disease:

ICD-10-CM Alphabetic Index: Disease > Kidney > Chronic > Stage 3 > N18.30. Verify the code in the Tabular List. Under code section N18 there is an instructional note telling us to code first hypertensive chronic kidney disease (I12-I13).

This confirms our sequencing.

According to ICD-10-CM guideline I.C.9.a, there is a presumed causal relationship between hypertension and heart involvement. In this case, the patient has hypertension and congestive heart failure.

Question 12/13

Rationale: ICD-10-CM Alphabetic Index: Hypertension > Kidney > Stage 5 chronic kidney disease (CKD) or end stage renal disease (ESRD) > I12.0.

An instructional note under I12.0 indicates to use additional code to identify the stage of the CKD.

ICD-10-CM Alphabetic Index: Disease > Kidney > Chronic > Stage 5 > N18.5. Verify the code in the Tabular List. Under code section N18 there is an instructional note telling us to code first hypertensive chronic kidney disease (I12-I13).

ICD-10-CM guideline I.C.9.a.1 indicates if the documentation does not have a causal relationship between the hypertension and heart disease, the conditions are coded separately.

 ICD-10-CM Alphabetic Index for Disease > Myocardium, myocardial > I51.5. Verify code selection in the Tabular List.

ICD-10-CM guideline I.C.9.a.2 indicates that ICD-10-CM presumes a causal relationship between chronic kidney disease (CKD) and hypertension.

Question 14

According to ICD-10-CM guideline I.C.9.e.1, the ICD-10-CM codes for acute myocardial infarction (AMI) identify the site, such as anterolateral wall or true posterior wall. The same section goes on to state that if STEMI converts to NSTEMI due to thrombolytic therapy, it is still coded as STEMI.

Question 15

Rationale:

ICD-10-CM Alphabetic Index: Infarct, infarction > Myocardium, myocardial (acute) (with stated duration of 4 weeks or less) > ST elevation (STEMI)/anterior (anteroapical) (anterolateral) (anteroseptal) (Q wave) (wall) > I21.09.

Verify code selection in the Tabular List.

According to ICD-10-CM guideline I.C.9.e.1, the ICD-10-CM codes for acute myocardial infarction (AMI) identify the site, such as anterolateral wall or true posterior wall. The same section goes on to state that if STEMI converts to NSTEMI due to thrombolytic therapy, it is still coded as STEMI.

Question 16

Rationale:

ICD-10-CM Alphabetic Index: Infarct, infarction > Cerebral > Due to > Occlusion NEC > Cerebral arteries > I63.5-. Verify in the Tabular List. Report I63.512 Cerebral infarct due to unspecified occlusion or stenosis of left middle cerebral artery.

This patient has a history of CVA with left-sided hemiplegia and aphasia and is right-handed.

ICD-10-CM Alphabetic Index: Sequelae (of) > Infarction > Cerebral > Hemiplegia > I69.35-. Also look for Sequelae > Infarction > Cerebral > Aphasia > I69.320. Verify in the Tabular List I69.354 Hemiplegia and hemiparesis following cerebral infarction affecting left non-dominant side.

ICD-10-CM guideline I.C.9.d.2

Question 17

Rationale:

ICD-10-CM Alphabetic Index: Hypertension (malignant) > I10. Malignant is a nonessential modifier that does not change the code assignment.

ICD-10-CM Alphabetic Index: Cardiomegaly, which states to “see also” Hypertrophy > Cardiac. In this case we would follow the “see also” note, because none of the subterms in the index pertain. 

ICD-10-CM Alphabetic Index: Hypertrophy > Cardiac (chronic) (idiopathic)> I51.7. Verify code selection in the Tabular List.

According to ICD-10-CM guideline I.C.9.a.1, if the documentation states that the hypertension and heart disease are unrelated, the conditions are coded separately.

Question 18

Rationale:

ICD-10-CM Alphabetic Index for Failure > Heart > Diastolic (congestive) (left ventricular) > Chronic (congestive) > and (on) Acute (congestive) > I50.33.

ICD-10-CM Alphabetic Index: Hypertension > I10. Verify code selection in the Tabular List.

I50.33 Acute on chronic heart failure is sequenced as the principal diagnosis, because it is the condition chiefly responsible for occasioning the admission to the hospital.

ICD-10-CM Alphabetic Index: Sequelae (of) > Hemorrhage > Intracerebral > Hemiplegia > I69.15- Verify code selection in the Tabular List, where the 6^th digit is obtained for the Right dominant side being affected > I69.151.

Refer to ICD-10-CM guideline section II.

ICD-10-CM guideline I.C.9.a.1 indicates when the documentation specifically states the two conditions are unrelated between hypertension and heart disease, they are coded separately. In this case, there is no causal relationship coded.

ICD-10-CM guideline I.C.9.d.1 that states if the right side is affected and we don’t know the dominant side, then the default is dominant.

Question 19

ICD-10-CM Alphabetic Index: Disease, diseased, coronary (artery) – “see” Disease, heart, ischemic, athero-sclerotic. Disease, heart, ischemic, atherosclerotic (of) > with angina pectoris – “see” Arteriosclerosis, coronary (artery), native vessel, with angina pectoris. Arteriosclerosis, arteriosclerotic (diffuse) (obliterans) (of) (senile) (with cal-cification), coronary (artery) > native vessel > with > angina pectoris.

Rationale: ICD-10-CM has combination codes for atherosclerotic heart disease with angina pectoris. There are subcategories for disease of the native artery, coronary artery bypass graft(s), and coronary artery of transplanted heart. It is not necessary to use an additional code for angina pectoris when using these combination codes.

Question 20

ICD-10-CM Alphabetic Index: Infraction > Myocardium > NSTEMI > I21.4. Verify the code in the tabular.

ICD-10-CM Alphabetic Index: Fibrillation > Atrial or auricular (established) > I48.91. Verify the code in the tabular.

Question 21

ICD-10-CM Alphabetic Index: Infarction > Myocardium > NSTEMI > Subsequent > I22.2

ICD-10-CM Alphabetic Index: Infarction > Myocardium > STEMI > Inferior (wall) > I21.19

ICD-10-CM Alphabetic Index: Fibrillation > Atrial or auricular (established) > I48.91.

Verify the codes in the tabular.