By Dr. Richard Pinson, MD, FACP, CCS
Q. If a patient has severe mitral valve regurgitation due to torn/ruptured chordae tendineae and has to have chords replaced and annuloplasty, can we code both the regurgitate and torn chords? If so, which would you consider primary diagnosis?
A. Thanks for this intriguing question.
The chordae tendineae (“tendinous cords”), quaintly known as the “heart strings” upon which love songs are played, are thread-like cords of fibrous tissue which attach at one end to the edges of the tricuspid and mitral valves of the heart and on the other end to the papillary muscles, small muscles within the heart that serve to anchor the valves in place.
Rupture of mitral chordae tendineae (code I51.1 or I23.4 depending on the cause – spontaneous vs. due to MI, respectively) disconnects the link between the mitral valve and the left ventricle, causing mitral valve regurgitation (I34.0). ICD-10-CM does not prohibit assignment of both codes for the same encounter.
Rupture is an acute, potentially life-threatening condition requiring prompt repair if symptomatic (typically acute severe heart failure). The preferred treatment method is mitral valve repair rather than valve replacement. Valve repair is associated with a lower operative mortality, preservation of left ventricular function, better long-term survival and avoids the risks of a prosthetic valve and anticoagulation.
Clinically speaking, the mitral regurgitation is the direct result of the ruptured chordae. As described in detail in our CDI Pocket Guide, when two interrelated conditions (such as diseases in the same ICD-10-CM chapter or manifestations characteristically associated with a certain disease) potentially meet the definition of principal diagnosis, either condition may be sequenced first, unless the circumstances of the admission, the therapy provided, the Tabular List, or the Alphabetic Index indicate otherwise.
Chordae rupture of the tricuspid valve is relatively rare and has less severe consequences than mitral chordae rupture although elective surgical repair is sometimes necessary.
The Pinson & Tang CDI Pocket Guide provides specific standardized query templates for the most common medical conditions as well as instruction on how to modify the template to fit the particular circumstances of the case in question.
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About the Author
Dr. Richard Pinson, MD, FACP, CCS
Dr. Richard Pinson is a physician, educator, administrator, and healthcare consultant. He practiced Internal Medicine and Emergency Medicine in Tennessee for over 20 years having board certification in both. Dr. Pinson is a Fellow of the American College of Physicians and former Assistant Professor of Clinical Medicine at Vanderbilt, and has assisted hospitals as a physician consultant for the past ten years. Dr. Pinson’s personal understanding of the mindset of both doctors and managers allows him a unique vantage point from which to promote cooperation between physicians, hospital staff, and administrators toward achieving beneficial and practical changes.