AMA CPT® Assistant - 2015 Issue 6 (June)

ICD-10-CM Case Scenario (June 2015)

June 2015 page 9 ICD-10-CM Case Scenario A 75-year-old female is seen in follow-up for chronic hypertension. She has been having ongoing shortness of breath and orthopnea. Recent electrocardiogram (ECG) demonstrates findings consistent with left ventricular hypertrophy, but there have been no changes since her previous ECG. Her echocardiogram reveals increased left ventricular wall thickness and a reduced ejection fraction of 38%. Currently, she is taking furosemide, enalapril, and atenolol. Examination Blood Pressure = 175/95; Heart Rate = 100 bpm [beats per minute] Assessment Poorly controlled hypertension. Hypertensive chronic combined systolic and diastolic congestive heart failure. Code Assignment The...

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CPT® Assistant content is the official source for CPT® coding guidance. It is an instrumental tool when appealing insurance denials and validating coding to auditors. Monthly issues and an extensive archive provide comprehensive guidance on proper CPT® coding for past, present and upcoming code set releases. Archives date back to 1990 for historical use of codes, changes, rationales, coding tips and trends in the industry.

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