Medical Coding for Ventricular Septal Defect (VSD) - An Overview The article discusses the symptoms, diagnosis and coding guidelines for Ventricular septal defect (VSD), the most common congenital birth defect
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A Ventricular septal defect (VSD) (more commonly known as ventral septal defect) is a hole in the septum (the wall) between the lower chambers of your heart (ventricles). According to the National Institutes of Health, VSDs are one of the most common congenital birth defects. The hole (defect) can occur anywhere in the muscles that separate the two chambers of the heart and allow blood to pass from the left to the right side of the heart. A small ventral septal defect does not cause any symptoms/problems and may close on their own. On the other hand, if the hole is large, the heart may have to pump too much blood in to the lungs to deliver enough oxygen to the body. Medium or larger VSDs may cause a range of complications such as heart failure, endocarditis, pulmonary hypertension and other heart problems. Treatment involves surgical repair early in life to prevent complications. The challenges of diagnosing and coding ventricular septal defect and associated conditions are numerous. Medical coding outsourcing is a feasible option worth considering as this can help physicians effectively handle coding challenges and ensure accurate and timely claim filing and reimbursement. Reports from the Centers for Disease Control and Prevention (CDC) suggest that an estimated 42 of every 10,000 babies are born with a ventricular septal defect. It is estimated that about 1 in every 240 babies born in the United States each year are born with a VSD. Congenital heart defects arise from problems early in the heart’s development, but the exact causes are often not clear. Genetics and environmental factors may play an active role. VSDs can occur alone or with other congenital heart defects and can be present in several locations in the wall between the ventricles. In addition, there may be one or more VSD of various sizes. It is also possible to acquire a VSD later in life, usually after a heart attack or as a complication following certain heart procedures. Signs and Symptoms Signs and symptoms of ventricular septal defect often appear during the first few days, weeks of months of a child’s life. A physician may first suspect a heart defect as part of a regular checkup if he/she hears a murmur when listening to a baby’s heart beat with a stethoscope. In some cases, VSDs can be detected by ultrasound before the baby is born.
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Signs and symptoms vary depending on the size of the hole and other associated heart defects. In some children, if the hole in their heart is small, symptoms may not appear until later in childhood. However, if the hole is large, the baby might have symptoms, including – •
Shortness of breath
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Fast or heavy breathing
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Sweating
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Tiredness while feeding
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Poor weight gain
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Pale skin coloration
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Frequent respiratory infections
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A bluish skin color, especially around the lips and fingernails
This type of congenital birth defects is quite common in families having genetic problems such as “Down Syndrome”. For couples, who already have a child with a heart defect, a genetic counselor can discuss the potential risk of their next child having the same defect. Early Diagnosis and Treatment Methods One of the early symptoms of ventricular septal defects (VSDs) involves a heart murmur that a physician can hear while using a stethoscope. If the physician hears a distinct “whooshing sound”, called a heart murmur during a physical examination, he/she may conduct several types of tests to in order to confirm the diagnosis. Several diagnostic imaging tests may be conducted which includes – echocardiogram, chest X-rays, electrocardiogram (ECG), cardiac catheterization, pulse oximetry and MRI to detect other associated cardiac abnormalities. All babies born with a ventricular septal defect (VSD) won't need surgery to close the hole. If the VSD is small and not causing any symptoms, physicians may follow a wait-and-watch approach to see if the defect gets corrected by itself. Physicians will carefully monitor the baby’s condition to make sure if the hole
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(defect) closes on their own. In more severe cases, surgery is required to repair the damage. Often, infants who need surgical repair have the procedure done it in their first year. Most surgical treatments for VSDs are open-heart procedures that involve plugging or patching the abnormal opening between the ventricles. Common surgical procedures include - Surgical repairs, Catheter procedure and Hybrid procedure. In some cases, medications may be prescribed before surgery to decrease the amount of fluid in circulation and in the lungs and keep the heartbeat regular. Medications include – digoxin, Digitalis lanata, diuretics and beta blockers such as metoprolol (Lopressor), propranolol (Inderal LA) and others, and digoxin (Lanoxin, Lanoxin Pediatric). Thoracic and cardiovascular surgery medical coding involves the use of specific ICD-10 codes and CPT codes to document different congenital conditions, including ventricular septal defect (VSD). The following medical codes are used – ICD- 10 Codes •
Q21 - Congenital malformations of cardiac septa
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Q21.0 - Ventricular septal defect
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Q21.1 - Atrial septal defect
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Q21.2 - Atrioventricular septal defect
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Q21.3 - Tetralogy of Fallot
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Q21.4 - Aortopulmonary septal defect
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Q21.8 - Other congenital malformations of cardiac septa
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Q21.9 - Congenital malformation of cardiac septum, unspecified
CPT Codes • 93580 - Percutaneous transcatheter closure of congenital interatrial communication (i.e., Fontan fenestration, atrial septal defect) with implant
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• 93581 - Percutaneous transcatheter closure of a congenital ventricular septal defect with implant •
93582 - Percutaneous transcatheter closure of patent ductus arteriosus
• 93583 - Percutaneous transcatheter septal reduction therapy (eg, alcohol septal ablation) including temporary pacemaker insertion when performed HCPCS Codes •
C1817 - Septal defect implant system, intracardiac
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C1769 - Guide wire
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C2628 - Catheter, occlusion
For infants suffering from small septal defects, physicians will carefully monitor their symptoms to see if the hole in the heart closes on its own. In most cases, surgery involves high success rate and long-term outcomes. However, recovery time will mainly depend on the size and type of the defect and whether there are any additional health or heart problems. Medical coding for Ventricular septal defects (VSDs) can be a challenging process.For accurate and timely medical billing and claims submission, healthcare practices can outsource their medical coding tasks to an established medical billing company. Such companies have experienced AAPC-certified coders who are knowledgeable about coding and billing guidelines for this specialty and can ensure accurate claims for optimal reimbursement.
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