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Resolved Elevated Troponin - R77.8 Index vs R79.89 AHA Coding Clinic

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Tiffany

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Hi Alicia,

I have a question for you. There is a Coding Clinic that was published (2019 Issue 2) stating that we are to assign code R79.89, Other specified abnormal findings of blood chemistry, for an elevated troponin level and "Codes R77.9 and R74.8" are not appropriate as "troponin is neither a serum enzyme nor a plasma protein." https://www.findacode.com/code.php?set=ICD10CM&c=R77.8.

However, elevated troponin indexes to R77.8 (Other specified abnormalities of plasma proteins) by Elevated, elevation/troponin, so my question is do we code elevated troponin by what Coding Clinic says or do we code elevated troponin by the index? I have never come across this before where Coding Clinic says to code a condition one way but the condition is able to be indexed and codes another way.
 
If it helps, you're not the only one that is confused by the conflicting information. It looks like ZHealth might have an answer, but it requires a membership.

That said, over the years I've noticed that American Hospital Association (AHA) Coding Clinic is an authority to follow for coding. So I would default to their recommendation since they felt it was necessary to make the clarification in the first place. That is, they took a commonly used code and felt the need to publish a correction with a valid reason (granted the definition of troponin hasn't changed since then).

Looks like ICD10Monitor also picked it up and reported on it...

The next coding scenario I’d like to highlight is one I’ve encountered several times, “elevated troponin.” The question focuses on whether this is an elevated serum enzyme, a plasma protein, or blood chemistry? The answer from Coding Clinic is that elevated troponin is a blood chemistry, and we would assign the ICD-10-CM code for “Other specified, abnormal finding of blood chemistry.” I’m sure this will be helpful advice for many.

That quoted reasoning above would rule out R77.9, R77.8 and R74.8 since they rely on it being plasma protein.

My 2 cents on the matter. (Not sure if those 2 cents even qualify as currency here.) :giggle:

Thanks for the brief rabbit hole! 🐇
 
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Yes I was confused as well so we decided to ask Alicias opinion.

Your 2 cents makes sense though Jesus.
 
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