The article discusses the symptoms, diagnosis and coding guidelines for Ventricular septal defect (VSD), the most common congenital birth defect.

1. Medical Coding for Ventricular
Septal Defect (VSD) - An Overview
The article discusses the symptoms,
diagnosis and coding guidelines for
Ventricular septal defect (VSD), the most
common congenital birth defect
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A Ventricular septal defect (VSD) (more commonly known as ventral septal
defect) is a hole in the septum (the wall) between the lower chambers of your heart
(ventricles). According to the National Institutes of Health, VSDs are one of the
most common congenital birth defects. The hole (defect) can occur anywhere in
the muscles that separate the two chambers of the heart and allow blood to pass
from the left to the right side of the heart. A small ventral septal defect does not
cause any symptoms/problems and may close on their own. On the other hand, if
the hole is large, the heart may have to pump too much blood in to the lungs to
deliver enough oxygen to the body. Medium or larger VSDs may cause a range of
complications such as heart failure, endocarditis, pulmonary hypertension and
other heart problems. Treatment involves surgical repair early in life to prevent
complications. The challenges of diagnosing and coding ventricular septal defect
and associated conditions are numerous. Medical coding outsourcing is a feasible
option worth considering as this can help physicians effectively handle coding
challenges and ensure accurate and timely claim filing and reimbursement.
Reports from the Centers for Disease Control and Prevention (CDC) suggest that
an estimated 42 of every 10,000 babies are born with a ventricular septal defect. It
is estimated that about 1 in every 240 babies born in the United States each year
are born with a VSD. Congenital heart defects arise from problems early in the
heart’s development, but the exact causes are often not clear. Genetics and
environmental factors may play an active role. VSDs can occur alone or with other
congenital heart defects and can be present in several locations in the wall between
the ventricles. In addition, there may be one or more VSD of various sizes. It is
also possible to acquire a VSD later in life, usually after a heart attack or as a
complication following certain heart procedures.
Signs and Symptoms
Signs and symptoms of ventricular septal defect often appear during the first few
days, weeks of months of a child’s life. A physician may first suspect a heart defect
as part of a regular checkup if he/she hears a murmur when listening to a baby’s
heart beat with a stethoscope. In some cases, VSDs can be detected by ultrasound
before the baby is born.

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Signs and symptoms vary depending on the size of the hole and other associated
heart defects. In some children, if the hole in their heart is small, symptoms may
not appear until later in childhood. However, if the hole is large, the baby might
have symptoms, including –
• Shortness of breath
• Fast or heavy breathing
• Sweating
• Tiredness while feeding
• Poor weight gain
• Pale skin coloration
• Frequent respiratory infections
• A bluish skin color, especially around the lips and fingernails
This type of congenital birth defects is quite common in families having genetic
problems such as “Down Syndrome”. For couples, who already have a child with a
heart defect, a genetic counselor can discuss the potential risk of their next child
having the same defect.
Early Diagnosis and Treatment Methods
One of the early symptoms of ventricular septal defects (VSDs) involves a heart
murmur that a physician can hear while using a stethoscope. If the physician hears
a distinct “whooshing sound”, called a heart murmur during a physical
examination, he/she may conduct several types of tests to in order to confirm the
diagnosis. Several diagnostic imaging tests may be conducted which includes –
echocardiogram, chest X-rays, electrocardiogram (ECG), cardiac catheterization,
pulse oximetry and MRI to detect other associated cardiac abnormalities.
All babies born with a ventricular septal defect (VSD) won't need surgery to close
the hole. If the VSD is small and not causing any symptoms, physicians may
follow a wait-and-watch approach to see if the defect gets corrected by itself.
Physicians will carefully monitor the baby’s condition to make sure if the hole

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(defect) closes on their own. In more severe cases, surgery is required to repair the
damage.
Often, infants who need surgical repair have the procedure done it in their first
year. Most surgical treatments for VSDs are open-heart procedures that involve
plugging or patching the abnormal opening between the ventricles. Common
surgical procedures include - Surgical repairs, Catheter procedure and Hybrid
procedure. In some cases, medications may be prescribed before surgery to
decrease the amount of fluid in circulation and in the lungs and keep the heartbeat
regular. Medications include – digoxin, Digitalis lanata, diuretics and beta blockers
such as metoprolol (Lopressor), propranolol (Inderal LA) and others, and digoxin
(Lanoxin, Lanoxin Pediatric).
Thoracic and cardiovascular surgery medical coding involves the use of specific
ICD-10 codes and CPT codes to document different congenital conditions,
including ventricular septal defect (VSD). The following medical codes are used –
ICD- 10 Codes
• Q21 - Congenital malformations of cardiac septa
• Q21.0 - Ventricular septal defect
• Q21.1 - Atrial septal defect
• Q21.2 - Atrioventricular septal defect
• Q21.3 - Tetralogy of Fallot
• Q21.4 - Aortopulmonary septal defect
• Q21.8 - Other congenital malformations of cardiac septa
• Q21.9 - Congenital malformation of cardiac septum, unspecified
CPT Codes
• 93580 - Percutaneous transcatheter closure of congenital interatrial
communication (i.e., Fontan fenestration, atrial septal defect) with implant

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• 93581 - Percutaneous transcatheter closure of a congenital ventricular septal
defect with implant
• 93582 - Percutaneous transcatheter closure of patent ductus arteriosus
• 93583 - Percutaneous transcatheter septal reduction therapy (eg, alcohol
septal ablation) including temporary pacemaker insertion when performed
HCPCS Codes
• C1817 - Septal defect implant system, intracardiac
• C1769 - Guide wire
• C2628 - Catheter, occlusion
For infants suffering from small septal defects, physicians will carefully monitor
their symptoms to see if the hole in the heart closes on its own. In most cases,
surgery involves high success rate and long-term outcomes. However, recovery
time will mainly depend on the size and type of the defect and whether there are
any additional health or heart problems.
Medical coding for Ventricular septal defects (VSDs) can be a challenging
process.For accurate and timely medical billing and claims submission, healthcare
practices can outsource their medical coding tasks to an established medical billing
company. Such companies have experienced AAPC-certified coders who are
knowledgeable about coding and billing guidelines for this specialty and can
ensure accurate claims for optimal reimbursement.