Coding corner: What to know when coding for vascular disease

Vascular disease is any abnormal condition of the blood vessels and includes conditions that affect the circulatory system. There are many risk factors for vascular diseases, including aging, a family history of vascular or heart disease, diabetes, high cholesterol, hypertension, smoking and obesity.

Here are some important things to keep in mind when coding for vascular disease:

• Is the condition considered part of a patient’s past medical history that no longer requires any form of treatment?
• Does the patient have a chronic condition? State the acuity and note the current treatment.
• Is the current condition a manifestation of a chronic condition? (e.g., diabetic angiopathy)

Peripheral vascular disease
One disease of the vascular system is peripheral vascular disease, or PVD. Sometimes referred to as peripheral arterial disease or peripheral angiopathy, PVD is a circulatory condition resulting in reduced blood flow to the extremities, typically occurring in the legs. The American Heart Association defines PVD as diseases of blood vessels outside the heart and brain. It’s often a narrowing of vessels that carry blood to the legs, arms, stomach or kidneys.

The most common symptom of PVD is intermittent claudication, which is pain while walking that resolves after a few minutes of rest. The location of the pain depends on the site of the narrowed or clogged artery.

To code PVD to the highest specificity, look for these key components:

• Location of vein or artery affected
• Complications such as intermittent claudication, ulceration or pain at rest
• Laterality — left, right or bilateral
• The cause, if known
• Whether gangrene is present

If PVD is noted without further specificity, use ICD-10 code I73.9, Peripheral vascular disease, unspecified. This code also includes intermittent claudication, peripheral angiopathy NOS and spasm of artery.

Peripheral vascular disease and diabetic complications
Documentation is extremely important when PVD is a manifestation associated with a specific condition. Peripheral vascular disease codes require a fourth – and sometimes – a fifth digit.

Examples below show coding with the required fifth digit:

• E11.51 Type 2 diabetes mellitus with diabetic peripheral angiopathy without gangrene
• E10.51 Type 1 diabetes mellitus with diabetic peripheral angiopathy without gangrene

According to the AHA Coding Clinic (Fourth Quarter, 2016), considered an official resource by the Centers for Medicare & Medicaid Services, new instructions were released on the assumed cause-and-effect relationship between diabetes and certain diseases of the kidneys, nerves and circulatory system. These instructions are in accordance with the updates to the 2017, ICD-10-CM Official Guidelines for Coding and Reporting. Following is a look at the ICD-10-CM alphabetic index format for certain conditions linked to diabetes Type 2 using the subterm “with”:

Diabetes, diabetic (mellitus)(sugar) Type 2 E11.9 With
Amyotrophy E11.44 Chronic kidney disease E11.22 Circulatory complications E11.59 Peripheral angiopathy E11.51		Relationship assumed

If a provider has documented diabetes and peripheral angiopathy in a medical record, the conditions are assumed to be related even if the doctor doesn’t specifically document the relationship. However, if the doctor documents that the Type 2 diabetes mellitus isn’t the underlying cause of the peripheral angiopathy, the condition shouldn’t be coded as a diabetic complication. If the coder isn’t able to determine whether the Type 2 diabetes mellitus and peripheral angiopathy are related or the ICD-10-CM classification doesn’t provide coding instruction, it’s appropriate to query the doctor for clarification so that appropriate codes may be reported.

None of the information included herein is intended to be legal advice and as such it remains the provider’s responsibility to ensure that all coding and documentation are done in accordance with all applicable state and federal laws and regulations.