The Coding Challenge
Question: A 63-year-old male patient is seen with complaints of leg pain while walking and while at rest. The patient also has hypertension and is a long-time tobacco smoker. Upon examination, the patient exhibits weak pulses in both lower extremities and a reduced ankle-branchial index. Imaging tests are taken and confirm a diagnosis of peripheral artery disease. Assign for ICD-10-CM.
A. I73.89, I15.9, F17.200
B. I73.9, I10, F17.210
C. I73.89, I10, F17.210
D. I73.9, I11.9, F17.200
B. I73.9, I10, F17.210
Locate and Verify
Peripheral Artery Disease
The ICD-10-CM codes for peripheral artery disease reside in Chapter 9. Disease of the circulatory system (I00-I99).
In the ICD-10-CM Alphabetic Index, look up Disease, diseased/artery/ peripheral/arterial I73.9.
In the Tabular, we can verify the correct code as:
I73.9, Peripheral vascular disease, unspecified
Peripheral angiopathy NOS
Spasm of artery
Since the type of PAD is not indicated, we must use the unspecified code. The ICD-10-CM Official Guidelines for Coding and Reporting instruct the coder to use an unspecified code when the information in the medical record is insufficient to assign a more specific code. For those categories where an unspecified code is not provided, the “other specified” code may represent both other and unspecified.
Look up Hypertension, hypertensive (accelerated) (benign) (essential) (idiopathic) (malignant) (systemic) I10.
In the Tabular, we can verify our correct code as:
I10, Essential (primary) hypertension
Includes: high blood pressure
hypertension (arterial) (benign) (essential) (malignant) (primary) (systemic)
A “Use additional” note instructs the coder to identify:
- exposure to environmental tobacco smoke (Z77.22)
- history of tobacco dependence (Z87.891)
- occupational exposure to environmental tobacco smoke (Z57.31)
- tobacco dependence (F17.-)
- tobacco use (Z72.0)
The patient is diagnosed as a long-time tobacco smoker in this coding scenario. Therefore, we need to look at F17.- for tobacco dependence.
Look up Dependence (on) syndrome)/tobacco – see Dependence, drug, nicotine/cigarettes F17.210. You can also look it up by starting with Tobacco (nicotine)/dependence/see Dependence, drug, nicotine/cigarettes F17.210.
Verifying this code in the Tabular, we see:
F17.210, Nicotine dependence, cigarettes, uncomplicated
A, C, and D are incorrect.
A. I73.89, I15.9, F17.200. I73.89 is for Other specified peripheral vascular diseases. I15.9 is for Secondary hypertension, unspecified. F17.200 is for Nicotine dependence, unspecified, uncomplicated.
C. I73.89, I10, F17.210. I73.89 is for Other specified peripheral vascular diseases.
D. I73.9, I11.9, F17.200. I11.9 is for Hypertensive heart disease without heart failure. F17.200 is for Nicotine dependence, unspecified, uncomplicated.
What is Peripheral Artery Disease?
Peripheral artery disease (PAD) or peripheral arterial disease is often used interchangeably with peripheral vascular disease (PVD). Peripheral artery disease is a circulation disorder caused by narrowing or blockage of the peripheral arteries that carry blood away from the heart to other areas of the body.
According to the National Heart, Lung, and Blood Institute, more than 8 million people in the United States aged 40 and older have PAD.
Cause of PAD: The CDC reports the primary cause of PAD is a buildup of fatty plaque in the arteries, called atherosclerosis. Although PAD can occur in any blood vessel, it is more common in the legs than the arms.
Signs and Symptoms: Pain in the legs with physical activity that gets better after rest is a classic symptom of peripheral artery disease. Some individuals have no leg pain. Other signs in the leg include muscle atrophy, hair loss, shiny skin or skin cool to the touch, decreased or absent pulses in the feet, nonhealing ulcers in the legs or feet, and numb or cold toes.
Risk Factors: Health conditions that increase the risk of PAD include smoking, high blood pressure, atherosclerosis, diabetes, and high cholesterol. Individuals over 60 years of age are also at an increased risk.
Diagnosis: PAD is diagnosed by a physician performing an ankle-brachial index (ABI) test to measure the blood pressure in the ankles. Imaging tests such as an ultrasound, magnetic resonance angiography (MRA), and computed tomographic (CT) angiography may also be performed.