** Based on ICD-9-CM Coding Clinic, End of Life of Heart Valve Prosthesis (2008 Vol 25 No 2), if the replacement was due to end of life, then the surgery wasn’t due to a complication and a complication code wouldn’t be appropriate. Instead look at V53.39. Here’s the Q&A:
Question: The patient was admitted due to end of life of the heart valve prosthesis. The cardiothoracic surgeon documents "prosthetic valve stenosis due to end of life." In ICD-9-CM, the index directs to code 996.71, Other complications of internal (biological) (synthetic) prosthetic device, implant, and graft, Due to heart valve prosthesis, for prosthetic valve stenosis. However, the surgeon does not agree with this code assignment. He stated that the patient's heart valve prosthesis was placed 19 years ago and has reached its end of life, which is an expected outcome, not a complication. How should end of life of the heart valve prosthesis be coded?
Answer: Assign code V53.39, Fitting and adjustment of other device, Other cardiac device, as the principal diagnosis. This situation would not be classified as a complication of the device since the device is eventually expected to wear out and the patient was not experiencing any problems due to the device. When the device is causing problems or complications, such as mechanical breakdown, a code from subcategory 996.6, Mechanical complications of cardiac device, implant and graft, is assigned.
** If this isn’t end-of-life, look at 996.71 (Other complications due to heart valve prosthesis) and 996.72 (Other complications due to other cardiac device implant and graft).
This ICD-9-CM Coding Clinic Q&A isn’t exactly on point, but it does point to use of an “other complication” code when stenosis is the issue:
Coronary Stent Stenosis (Code 996.72 vs. Code 996.74) (2001 Vol.18 No.3)
Question: In the First Quarter 2000 of Coding Clinic issue there was a question on the correct way to code coronary artery stent stenosis. The patient had developed intraluminal stenosis at both ends of a previously placed stent. The cardiologist explained that the stenosis was secondary to the formation of scar tissue as a result of the body's reaction to the stent. In answer to this question code 996.74, Other complications of internal (biological) (synthethic) prosthetic device, implant, and graft, Due to other vascular device, implant, and graft, was given. However it appears that 996.72, Other complications of internal (biological) (synthethic) prosthetic device, implant, and graft, Due to other cardiac device, implant, and graft, would be more appropriate.
Code 996.72 is indexed in the following manner:
graft NEC 996.72
Answer: Yes, you are correct. Code 996.72, Other complications of internal (biological) (synthetic) prosthetic device, implant, and graft, Due to other cardiac device, implant, and graft, is the appropriate code assignment for coronary artery stent stenosis. Effective October 1, 2000, "coronary stent occlusion" was specifically indexed to code 996.72. Please note that the current information supersedes that published in Coding Clinic, First Quarter 2000.