ICD-10-CM Coding Of Atherosclerotic Coronary Artery Disease And Angina Pectoris
By Lori Becks, RHIA
February 24, 2011
Coronary atherosclerosis is a condition in which the arteries of the heart become clogged with fatty plaque build-up that restricts the amount of blood flow through the arteries while simultaneously causing hardening of the arterial walls. Reporting coronary atherosclerosis in ICD-10-CM presents some differences from current ICD-9-CM coding that are worth noting.
Coronary atherosclerosis codes in ICD-9-CM are found in subcategory 414.0. Code selection is by type of vessel or graft: unspecified whether native or grafted vessel, native coronary artery, autologous vein bypass graft, arterial bypass graft, nonautologous biological bypass graft, unspecified type of bypass graft, or native artery or bypass graft of a transplanted heart. Codes for angina pectoris are reported in addition to coronary atherosclerosis codes when both conditions are present.
In ICD-10-CM, there is an assumed causal relationship in a patient with both coronary atherosclerosis and angina pectoris, as one will cause the other. ICD-10-CM provides combination codes for these two conditions that are selected when both are documented in the patient, unless the documentation specifically states that the angina pectoris is due to some other condition or disease process besides the atherosclerosis.
These ICD-10-CM combination codes for coronary atherosclerosis with angina pectoris are also selected by subcategories that distinguish between native coronary artery (I25.11), unspecified coronary artery bypass graft (I25.70),Â autologous vein bypass graft (I25.71),Â autologous artery bypass graft (I25.72), nonautologous biological bypass graft (I25.73), native coronary artery of transplanted heart (I25.75), bypass graft of transplanted heart (I25. 76), and other coronary artery bypass graft (I25.79).
These combination code subcategories are further broken down to the level of granularity valid for reporting, as in the following example:
When angina pectoris is not present, the appropriate atherosclerosis code stating â€˜without angina pectorisâ€™ should be reported, such as:
Cases of angina alone without coronary atherosclerosis require documentation regarding specific characteristics such as stable, unstable, or the presence of spasm. Differences to note when coding cases of angina alone in ICD-10-CM vs ICD-9-CM include:
As a final note, when a patient with coronary artery disease is admitted due to an acute myocardial infarction, the infarction should be sequenced before the code(s) for the coronary artery disease, whether in ICD-10-CM or ICD-9-CM.
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