ICD-11 circulatory system: Understanding the heart of the matter

The International Classification of Diseases (ICD) has undergone a significant transformation with its 11th edition, particularly in Chapter 11, which focuses on the circulatory system. This chapter reflects the latest advancements in medical knowledge, disease patterns and treatment outcomes. Let’s take a closer look into the rationale behind these changes and what it means for healthcare professionals and patients.

Why the change is necessary

The landscape of cardiovascular diseases has evolved dramatically since the publication of ICD-10 more than two decades ago. Improved survival rates following procedures, shifts in disease profiles and advancements in clinical practices necessitated a comprehensive update. ICD-11 includes a broader spectrum of disease entities, new classification hierarchies and updated nomenclature to stay abreast of these developments.

A shift in focus

Developed countries have seen a decline in rheumatic fever as a predominant cause of heart valve disease, although it remains a significant concern in developing nations. This shift has led to changes in treatment approaches, prioritizing valve type and pathology before considering etiology.

New categories and instructions 

Today, cardiologists face clinical issues that were once grouped under “Other forms of heart disease,” in ICD-10. To address this, ICD-11 has introduced distinct higher level categories, such as diseases of the myocardium and cardiac arrhythmia, including subsections on genetic disorders and device dysfunctions.

Relocation for relevance 

To ensure clinical relevance, conditions primarily managed by non-cardiologists have been moved to more appropriate chapters. For instance, cerebrovascular diseases now reside in Chapter 8, “Diseases of the nervous system,” and esophageal varices have found a new home in Chapter 13, “Diseases of the digestive system.” Additionally, acute rheumatic fever has been moved from the circulatory chapter in ICD-10-CM to infectious diseases in ICD-11.

Coding for the future

ICD-11 introduces new coding instructions and special guidelines, such as the addition of secondary hypertension codes, in clusters, to indicate treatment relevance. It also incorporates the New York Heart Association (NYHA) Functional Classification to help assess and monitor heart failure patients, guide clinical decision making and patient treatment plans. The NYHA classification system is a widely recognized method used to categorize the severity of heart failure based on the patient’s symptoms and their impact on physical activity. These classification codes are not available in ICD-10-CM.

Looking at the table below, we can see there are differences between the tabular list for ICD-10-CM and ICD-11 for the circulatory system. ICD-11 includes several code categories that are listed in other chapters within ICD-10-CM, including:

Coding

The following are some general circulatory diseases and the coding differences between ICD-10-CM and ICD-11: 

Chronic hypertensive heart disease with unspecified heart failure and NYHA Class II - Slight limitation of physical activity

Acute ST elevation (STEMI) myocardial infarction involving left main coronary artery

ICD-11 Chapter 11 changes are a testament to the dynamic nature of medicine. It offers a more granular and precise classification system that aligns with current clinical practices and patient care standards. As we embrace these changes, the healthcare community is better equipped to diagnose, treat and manage circulatory system diseases with greater accuracy and efficacy.

Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT, coding analyst at Solventum.

Karla VonEschen, MS, CCDS-O, CPT, CPMA is a clinical analyst at Solventum.