Success Codes—Cardiology Edition

For Clinicians and Organizations.



Time for another edition of my wildly popular “Success Codes” series. If you haven’t already, you may want to review my world class, yet humbly simple (yes, really) explanation of RAF scoring—it’ll help you understand some of the shorthand terminology below. It’s the only one on the web written by a PCP who’s been in the trenches blocking and tackling since Medicare Advantage first arrived on the scene 20+ years ago—and done so with incredible results.


That’s probably why it’s so good—and so good for you!  Now let’s get started.


Here again, you can trust that the severe, acute conditions; the strokes and the MIs will be coded correctly in the normal course of treatment.  But to really succeed, here are the only 10 cardiovascular codes you have to know.


Remember them, apply them correctly, document as appropriate.


And your performance will astound.



  • Stable Angina I20.9 RAF 0.14
    • Are they on short or longer term nitrates? consider this code.
  • Afib/flutter I48.xx RAF 0.3
    • This is an audit target—best to get it on EKG before submitting.
  • V fib I49.xx RAF 0.3
    • Did you address an implantable defibrillator that fired?
      • Submit the appropriate code based on the pacer record.
    • Very rarely submitted when the opportunity presents itself.
      • A very high value opportunity.
  • CHF I50.xx RAF 0.4
    • Includes Grade 1 diastolic dysfunction on echo—but only if you treated it.
  • Cardiomyopathies I42.xx RAF 0.3
  • Arterial Atherosclerosis I70.xx RAF 0.3
    • Site specific codes.
      • Any site below the neck associated with RAF of 0.3.
    • If there are manifestations the RAF is 0.5 on average.
      • Claudication
      • Ulcer
      • Reno-vascular Hypertension
    • Common incidental finding
      • As long as you addressed it, can be submitted as an addendum.
  • Arterial Aneurysms I71.xx RAF 0.4
    • Any arterial aneurysm, anywhere.
    • Exact code is site specific.
  • DVT acute or chronic RAF 0.3
    • Chronic DVT on low intensity anti-coagulation easy to overlook
      • Especially if patient stable for a long time.
      • When you see routine aspirin, always ask—don’t assume its for primary prevention.
  • Pulmonary Embolism, chronic I27.82 RAF 0.3
    • Chronic PE easy to overlook as well
  • Pulmonary Hypertension I27.2 RAF 0.3
    • Often over looked on echo
    • Usually measured on Cath, but often not noted—look for it!
    • Clear. objective definition—so it’s an easy audit risk.
      • Echo
        • Tricuspid Regurgitation Velocity > 3.4 m/sec and SPAP > 40 mm
      • Cardiac Cath
        • >24 mm hg on cardiac cath.











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