Aftercare Coding for Heart Valve Replacements

Like many coders, when coding aftercare for a valve replacement your first instinct may be to automatically assign V58.73 aftercare following surgery of the circulatory system because the heart valve is part of the circulatory system– this is incorrect.

The key to assigning the correct aftercare code for a heart valve replacement is to determine  whether a  mechanical or tissue heart valve was used to replace the diseased or damaged valve.

A mechanical heart valve is a prosthetic valve that replicates the natural heart valve. Types of mechanical valves include: caged-ball, tilting-disk, and bileaflet.

A tissue (bioprosthetic) heart valve is transplanted from another heart, whether it be a human or animal.  Types of tissue valves include: allograt/isograft and xenograft (pig valve). Sometimes, a tissue valve may be referred to as bioprosthetic.

When a mechanical heart valve is utilized as a replacement, the correct aftercare code is V58.73 aftercare following surgery of the circulatory system and  include V43.3  heart valve replaced by other means-prosthetic.

On the other hand, when a tissue valve is used to replace a heart valve, the correct aftercare code is V58.44 aftercare following organ transplant with V42.2 heart valve replaced by transplant.

Refer to the patients operative report for the type of valve used.

Coding Coronary Artery Disease (CAD)

Coding Coronary Artery Disease (CAD) may seem straightforward but, there is specific information needed before you can accurately assign a CAD code. Carefully review the patient’s chart to determine if CAD is affecting the native arteries or grafted arteries. If the patient has had a CABG in the past, there is a chance that CAD is present in the grafted arteries rather than in the native arteries. If this is the case assign a code from the range  414.02-414.05. Also remember to assign  V45.81 CABG Status to show the patient’s surgical history and extent of CAD. If the patient does not have a history of a CABG surgery, then you can assign code 414.01 CAD of native vessels. Always check your documentation before assigning an unspecified CAD code.