2025 ICD-10-CM code I27.83
(Active) Effective Date: N/A Revision Date: N/A Diseases of the circulatory system - Pulmonary heart disease and diseases of pulmonary circulation (I26-I28) Diseases of the circulatory system (I00-I99) Feed
Eisenmenger syndrome, a severe form of pulmonary hypertension with a right-to-left shunt due to a congenital heart defect.
Modifiers may be applicable to procedures performed in conjunction with the diagnosis of Eisenmenger syndrome.
Medical necessity for coding I27.83 is established through the presence of clinical symptoms and diagnostic confirmation of Eisenmenger syndrome. The diagnostic tests are medically necessary to assess the severity of the condition and guide management decisions.The underlying congenital heart defect, if present, would also be considered medically necessary to code for complete clinical picture.
Diagnosis and management of Eisenmenger syndrome involves a multidisciplinary approach including cardiology, pulmonology, and potentially surgery.Clinical responsibility would include conducting thorough physical examinations, ordering diagnostic tests (echocardiogram, cardiac catheterization, etc.), assessing the severity of the condition, and implementing appropriate management strategies (e.g., medication to manage symptoms, oxygen therapy, and surgical interventions if feasible).
- Diseases of the circulatory system (I00-I99)
- I27.83 falls under the broader category of pulmonary heart disease and diseases of pulmonary circulation (I26-I28) within Chapter 9 of ICD-10-CM, which covers diseases of the circulatory system.
In simple words: Eisenmenger syndrome is a serious heart condition where a birth defect in the heart causes blood to flow in the wrong direction, leading to high blood pressure in the lungs and blue-tinged skin.It's a long-term condition that develops from a problem present at birth.
Eisenmenger syndrome, also known as Eisenmenger complex or Eisenmenger's disease, is an irreversible form of pulmonary hypertension characterized by a right-to-left shunt resulting from a congenital heart defect.This condition arises when an initially left-to-right shunt (such as from an atrial septal defect, ventricular septal defect, or patent ductus arteriosus) reverses due to increased pulmonary vascular resistance.The reversal of blood flow leads to cyanosis and significant complications.The underlying congenital heart defect should also be coded if known (e.g., Q21.0 for ventricular septal defect, Q21.1 for atrial septal defect, Q25.0 for patent ductus arteriosus).
Example 1: A 25-year-old female patient presents with cyanosis, dyspnea on exertion, and a history of a ventricular septal defect diagnosed in childhood. Cardiac catheterization reveals a significant right-to-left shunt and elevated pulmonary vascular resistance, consistent with Eisenmenger syndrome.I27.83 is coded along with Q21.0 (Ventricular septal defect)., A 30-year-old male patient with a known history of atrial septal defect since birth experiences progressive dyspnea and fatigue.Echocardiography and right heart catheterization confirm Eisenmenger syndrome with elevated pulmonary artery pressure.I27.83 is used in conjunction with Q21.1 (Atrial septal defect)., A 40-year-old patient presents with symptoms indicative of Eisenmenger syndrome, including clubbing of the fingers, cyanosis, and exertional dyspnea.Diagnostic tests (echocardiography, cardiac catheterization) confirm the diagnosis, but the underlying congenital heart defect is not clearly identified. In this case, only I27.83 would be coded.
Complete medical history, physical examination findings (including cyanosis and clubbing), echocardiogram report demonstrating right-to-left shunt and elevated pulmonary vascular resistance, and cardiac catheterization results are essential for accurate coding. Documentation should include a clear statement confirming the diagnosis of Eisenmenger syndrome and the identification of the underlying congenital heart defect (if known).
** Eisenmenger syndrome is a severe and life-threatening condition requiring comprehensive management. Accurate coding is crucial for appropriate reimbursement and tracking of this rare disease.
- Payment Status: Active
- Modifier TC rule: Not applicable to this diagnosis code.
- Specialties:Cardiology, Pediatric Cardiology, Cardiac Surgery, Pulmonology
- Place of Service:Inpatient Hospital, Outpatient Hospital, Office