ICD-10-CM Specific Coding Guidelines -Circulatory Part ONE

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oh

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and your answer choices are a

i25.110 i

20.0

Z87 not uh

891 b

i25.110

z87.891 c

i25.110

f17.210 and d

I25

110

z72.0 a former smoker is seen for a

followup he has coronary artery disease

with unstable

angina good luck

coders

e

e

okay I think my clock was isn't working

or I didn't push it in time all right so

let's go ahead and let's highlight our

key

terms I'm inventorying former

smoker CAD coronary artery disease and

unstable

angena so I don't there's nothing I can

eliminate on site so I'm just going to

pull out the guideline and there's a

guideline

c9b it says when you have

atherosclerotic coronary artery disease

assd it's the same as CAD with angena

you're going to sequence first I2 5.11

assd with

angena or if the patient has a bypass

grafting I57 point I

25.7 and it says do not use a separate

angen code because it's bundle it's

integral all right so this patient does

have unstable angena and we're still

going to have to look up everything all

right so we've established that

i25.110 is correct because it's shared

by all four answers so let's go ahead

and take a

look

25110 oh but it's pointing me say hey

read these notes here okay I'm going to

get to that but I do want to look at

this okay it's telling me look at

unstable angena I 20.0 this is the code

for unstable angena so you could use

this code when a person does not have

CAD because the guideline says don't

code this with CAD it's integral all

right so I believe you so I'm going to

eliminate it I'm going to eliminate a

now let's go look at

i25.110

i25.110 look at this it's telling me to

eliminate these okay all right I

apologize so let's go ahead and read

these notes up above the I mean at the

boss level there are instructional notes

and if if as you can see it's telling

you these diagnoses and their codes that

are

codable however it's telling us that if

the patient has a history of tobacco

dependence you can code it but our um um

patient doesn't have documented a

history of tobacco dependence it just

says he's a former smoker right

so we're going to get rid of Z oh wait

wait wait wait wait I apologize it does

says he's a former smoker so let me tell

you why we're going to select that we're

going to select it because it's the best

of the four right so if you look at

f17.210

f17 this is tobacco dependence that

means this patient is dependent right

now right it's happening right now also

z72 2.0 is tobacco use that means that

patient is using it right now neither of

these are true so if the doc if the only

thing that we have left is history of

tobacco

dependence then we code it

clinically correct scenarios and answers

you shouldn't because when you take that

exam you're going to get thrown off

because you're going to see it a lot

yeah you have your job is to pick the

best of the four now to me this patient

I don't know if this patient has a

history of tobacco dependence but they

do have a history of tobacco use they

definitely do so that is the best of the

four but let's take a look at this code

i25.110 that I've been trying to get to

First

atherosclerotic heart disease of NATO

native coronary artery with angen

pectoris so this code bundles or

includes angena pectoris and you should

not code angena pectoris or unstable

angen additionally as per the guideline

so if you said be like you all did uhuh

let's go back

outstanding well most of you

did let me check and see got to go check

you out sometimes I can't see you yeah a

lot of you got that and don't get hung

up like I did say oh no it's not history

of tobacco dependence we have to choose

the best of the four outstanding job

everyone all right so I just want to end

this conversation about hypertension

remember the zero means no additional

specified diseases it's just

hypertension i1 means that you have one

heart remember that one heart means that

it's i1 and i12 that two means that you

have two kidneys and that's CKD

hypertension in the setting of CKD and

I13 means you have all three you have

hypertension you have heart disease and

CKD I think you all did a phenomenal job

how do you

feel you all feeling

good

mm somebody said yes

good what about the rest of you how do

you feel about cating hypertension more

practice you're going to blow it out of

the

water and a lot of you didn't look up

the

codes just saying or you eliminated some

answers without looking them up just

saying

outstanding all right coders it's time

to switch gears now I need your

attention on this one I do so please

humor

me all right so we're going to talk

about acute my cardial

infarction what is that well that's a

heart attack right yeah and these heart

attacks are usually caused by blockage

in the coronary arteries which reduces

or

stops the flow of

blood to the heart and that's critical

and when you have certain types of heart

attacks it damages the heart

muscle in fact that heart muscle can

die and when it dies it's

gone

right okay now there are two major types

of heart

attacks an n stemi and a

stemi now a

stemi results from the complete and

prolonged occlusion or blockage of an

epicardial

vessel epicardial is a vessel that sits

like right here on top of the

heart so any of these

vessels that are blocked for a prolonged

period of time could

cause a

St heart

attack now let's say what a stemi is a

stemi is the acronym for

St elevation myocardial

infarction and an n stemi is for non St

elevation my cardial infarction and en

stemies usually result from severe

coronary artery

narrowing and also you know um some um

transient

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occlusion Etc so stemies are more

complex than n stemi but they're both

severe all right and let's talk about

the difference between a

stemi and an N