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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),  autologous vein bypass graft (I25.71),  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:

  • I25.71 Atherosclerosis of autologous vein coronary artery bypass graft(s) with angina pectoris
  • I25.710 Atherosclerosis of autologous vein coronary artery bypass graft(s) with unstable angina pectoris
  • I25.711 Atherosclerosis of autologous vein coronary artery bypass graft(s) with angina pectoris with documented spasm
  • I25.718 Atherosclerosis of autologous vein coronary artery bypass graft(s) with other forms of angina pectoris
  • I25.719 Atherosclerosis of autologous vein coronary artery bypass graft(s) with unspecified angina pectoris

When angina pectoris is not present, the appropriate atherosclerosis code stating ‘without angina pectoris’ should be reported, such as:

  • I25.10 Atherosclerotic heart disease of native coronary artery without angina pectoris
  • I25.810 Atherosclerosis of coronary artery bypass graft(s) without angina pectoris

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:

  1. Code I20.0 Unstable angina, is listed under angina pectoris and includes intermediate coronary syndrome and preinfarction syndrome, which are coded to 411.1 in ICD-9-CM under other acute and subacute forms of ischemic heart disease, not under angina pectoris.
  2. There is no specific code for angina decubitus in ICD-10-CM, as there is in ICD-9-CM. This type is reported with the code for other forms of angina pectoris, I20.8.
  3. Prinzmetal angina and variant angina are coded as angina pectoris with documented spasm, code I20.1, in ICD-10-CM.

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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