745.4 Goes with Q21.0 to Explain VSD

Even one-to-one matches can surprise you -- check the index for clearness.

When the conversion of ICD-9 to ICD-10 takes place in 2013, one lesson you'll need to keep in mind is that inclusion lists may vary between the two code sets. That implies that ICD- 9 and ICD-10 codes that seem to be twins might not apply to the same list of diagnoses.

Case in point: ICD-9 2011 code 745.4 (Ventricular septal defect) as well as ICD-10 2011 code Q21.0 (Ventricular septal defect) have the same code definition. Both reference ventricular septal defect (VSD), which includes no less than one hole in the wall separating the ventricles of the heart. In the process of conversion of ICD-9 to ICD-10, you will find that regardless of the similarity in the code definitions, the inclusion lists for these codes are not the same.

ICD-9 coding rules: Code 745.4 has an inclusion note informing you that the code is suitable for Eisenmenger's defect or complex, Gerbode defect, interventricular septal defect, left ventricular-right atrial communication, or Roger's Disease.

ICD-10 changes: The inclusion list under Q21.0 shows only Roger's disease.As you will find differences in which diagnoses come under similar ICD-9 and ICD-10 codes, the fundamental principle of checking both the index and the tabular list will be essential for proper ICD-10 coding.

For instance, if you search for Eisenmenger's defect (which falls under 745.4), you'll find that ICD-10 codes this particular defect to Q21.8 (Other congenital malformations of cardiac septa). And in another instance of what's different, Eisenmenger's complex (which also falls under 745.4) is as an alternative coded to I27.89 (Other specified pulmonary heart diseases) under ICD-10.

Article Source :- http://www.supercoder.com/coding-newsletters/my-cardiology-coding-alert/icd-10-7454-matches-to-q210-to-describe-vsd-107520-article

Documentation: In case the patient has one of the named defects (for instance, those listed in the ICD-9 inclusion list), documentation of that definite name will let you check the index to be assured that you have the most suitable ICD-10 code.

You'll also require documentation to take account of whether the VSD is congenital (existing at or before birth), because of myocardial infarction, or or else acquired (a reaction to environmental influences). In the conversion of ICD-9 to ICD-10, you will experience that ICD-10 directs you away from Q21.0 in case the patient has an acquired septal defect (I51.0, Cardiac septal defect, acquired) or a VSD as a current complication of an acute myocardial infarction (I23.2, Ventricular septal defect as current complication following acute myocardial infarction).

Bonus tip: ICD-9 also has an exclusion list in 745.4, so you know not to use the code for common atrioventricular canal type (coded to 745.69, Other endocardial cushion defects) or single ventricle (coded to 745.3, Common ventricle) defects. In the conversion of ICD-9 to ICD-10, you will see that ICD-10 does not have an excludes list for Q21.0, but those diagnoses still are coded in another place: Q21.2 (Atrioventricular septal defect) is applicable to the common atrioventricular canal and Q20.4 (Double inlet ventricle) is applicable to the single or common ventricle diagnosis.