I'm not sure how everybody says this Medicare or this...
Laureen: Troponin.
Alicia: Yeah, I wouldn't have said troponin.
I was going to say...
Well, I'll say troponin now because you said it.
Now, I can't remember how I said it.
Q: What is the correct code for elevated troponin without mention of any definite diagnosis?
Okay, very good.
A: So, what we've got here is what actually is troponin?
It's creatine kinase.
That's probably not how you say it either but that's how I say kinase and sometimes
they call that CKs.
The ICD-9, they want to know what the ICD-9 code for that.
Well, see, it's a common problem because this is also known as CPK and it's phospo-creatine
kinase and sometimes wrongfully as creatinine kinase.
It's an enzyme present primarily in the heart and the skeletal muscles and also in the brain.
Now, what happens when you have these enzymes going on?
If these levels aren't just at the proper level for everything, then it will give people
a heart attack.
It will make you have horrible muscle spasms or you can have seizures.
Everybody, usually, doesn't think about the chemical balance of your body but you really
are made up of a whole batch of chemicals, and if they are just not right, you can have
some nasty repercussions.
Any injury to any of these structures will lead to a measurable increase in CK levels.
That means, let's say a person is walking down the street and they get hit on the head
with a baseball because they're walking by a game or something.
So, you think okay, they're walking around.
They're fine and everything, and then all of a sudden they have the seizure and they
are taken to the hospital and they're really, really sick.
Because trauma to the brain make these levels go wacky.
Let's say a person is...
Oh, gosh!
Think about those women who get anorexia.
They're not eating.
Their body is literally eating off of itself but your enzyme levels and some like that
all get screwed up and they'll have seizures.
They can have a heart attack but that's usually what kills these people that suffer from that.
It's the chemical imbalance and stuff in the body, not necessarily just the body.
That being said, 790.5 Other Nonspecific Abnormal Serum Enzyme Levels.
Extra Note from Alicia: 790.5 is used for nonspecific serum enzyme levels and CK is
specific.
So 790.5 would not be the correct code in this case.
Here is a website for more information: http://circ.ahajournals.org/content/45/2/471.full.pdf
Serum enzymes tests ares used to check for MI damage.
The troponin is a complex of three regulatory proteins that is integral to muscle contraction
in skeletal and cardiac muscle.
Elevated troponin levels indicate myocardial injury but may occur in critically ill patients.
As we scroll down, ICD-9 code for Elevated Troponin.
Again, what is the best code?
There is no ICD-9 code specifically for this particular enzyme or what's going on.
Now, there may be on ICD-10 but there is not for ICD-9.
What's the best code to use - 790.99 Other Abnormal Findings On Examination Of Blood.
So, with this definition, we would need to use 790.99 for the elevated troponin.
Now, as a coder, wanting to know how to be educated on this stuff, that's where you really
have to go and do the research; and if you're dealing with stuff like this, you're going
to have to go in and understand what some of these are.
This is not a common thing that happens, guys.
This is very rare, but it does happen.
I don't want to scare you and make you think that you've got to know what all of these
enzymes and stuff are.
If you come across something like this, you can usually query the doctor and say, "Okay,
I'm not really sure I understand what this is.
What's troponin?
What do I need to know so I can code to the highest specificity?"
and then get that information.
So, it's not something that you would just know.
I would say you would have to investigate to get this, okay, unless you really deal
with blood and enzymes all the time.
Laureen: Great!
And I wanted to share.
This is the site I use on how to pronounce things.
Alicia: Oh, good.
Laureen:It's called howjsay.com but I put in "kinase."
I don't think you could hear it when I did it, did you?
Alicia: No.
I can't hear it.
Laureen: Kay-nase or Kee-nase is what he said.
Alicia: Kee-nase?
Laureen: Yeah.
So, now I'm going to try troponin.
Alicia: Troponin.
I still think Laureen talks funny guys so I always giggle to myself, but then I have
this thing about accent so...
Laureen: Tropop-neen.
Wait a minute, one more time.
Alicia: No E.
Laureen: Tropo-neen.
Alicia: Tropo-neen.
That's how I said it without the "een."
That's how I was saying it to myself earlier today.
Tropop-onin.
Laureen: Sure, sure.
Alicia: Yeah, yeah.
Laureen: Very good.
Alicia: So you don't have to be perfect to be a coder guys.