# CAD diagnosis coding



## beichstadt (Jul 21, 2010)

All -

I am just wondering if anyone has any input on what actually dictates when you use the CAD diagnosis code?  
Would you code CAD in the following dictations:

mild luminal irregularities
mild CAD
a certain percentage of stenosis 20%, 30%, etc

I know this is kinda wide open, but I am just trying to get a feel of what others are doing.

Thanks in advance
Becky


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## KellyLR (Jul 21, 2010)

*CAD Coding*

Hello,

I couldn't resist the temptation when it comes to anything concerning CAD, heart, grafts, vascular, valves, etc.

I'm going to copy and paste a section of note that I received a WHILE back that clearly, unequivocally answered any of my concerns at that time. If you can use this, it was a pleasure to share this info.  I have shared this with many others. Some of it came from the AHA but I'm not sure of the publications. As follows:

Coronary artery disease (CAD) is a chronic ischemic condition where blood flow through the coronary arteries is impaired, most commonly due to atheromatous plaque. CAD is a progressive disorder that is silent for long periods of time then appears suddenly in the form of unstable angina or acute myocardial infarction (AMI). Unstable angina is marked by severe chest pain 
with little exertion and can progress into an AMI without immediate treatment. AMI is death to cells of the myocardium after prolonged ischemia. 

When coding for CAD, if the patient does not have a history of coronary artery bypass grafting (CABG), assign code 414.01. If the patient does have a history of a CABG, then assign the appropriate code from the 414.02-414.05 range. Codes 414.06 and 414.07 are used for CAD of a transplanted heart. Note that CAD of a previously bypassed vessel or of a transplanted heart is 
not considered a complication so a complication code should not be assigned. 

When coding for AMI, two factors must be known: the site or type of AMI and the episode of care for which the AMI pertains. All AMI codes fall under category 410. The fourth digit specifies the site or type of AMI (i.e., anterior wall, non-ST elevation MI, etc.). The fifth digit specifies whether the episode of care is unspecified, initial, or subsequent. The fourth digit of 9, unspecified site, and fifth digit of 0, unspecified episode of care, should never be used for inpatient encounters; query the physician for clarification. Follow the following sequencing guidelines when coding for manner. 

CAD and AMI: 

•When a patient is admitted for angina which is determined to be due to CAD, the CAD is sequenced first with an additional code for the angina. 
•When a patient is admitted for unstable angina and CAD and an AMI occurs after admission, the AMI is sequenced first with the CAD as an additional code. A code is not assigned for the unstable angina since it progressed into an AMI. Note: no code from category 411 is assigned with a code from category 410 unless the physician has documented postmyocardial infarction syndrome, postinfarction angina, or Dressler's syndrome. 
•When a patient is admitted for an AMI and CAD, the AMI is sequenced first with an additional code for the CAD. 
•When a patient is admitted for impending myocardial infarction and CHF and the AMI occurs after admission, the AMI is sequenced first with appropriate secondary codes for the CHF. CAD may be treated with diet and exercise in addition to medical treatment with medications. However, surgery may be required for more severe cases of CAD. Surgical treatments of CAD include percutaneous angioplasty, percutaneous stenting, or CABG. Coronary angioplasty or percutaneous transluminal coronary angioplasty (PTCA) is the dilation of a blocked artery with a balloon. PTCA is reported with the following codes: 

•00.66 â€“ PTCA 
•00.40-00.43 â€“ identifies the number of vessels treated 
•00.44 â€“vessel bifurcation, if performed (only report one time regardless of number of vessel bifurcations treated) 
•36.04 â€“infusion of platelet inhibitor or other intracoronary artery thrombolytic agent, if performed 
•99.10 â€“infusion of thrombolytic agent such as tissue plasminogen activator (TPA, if performed) 
Coronary stenting may also be performed in conjunction with a PTCA. Once the vessel has been dilated with the balloon, the physician will insert a stent to prevent reclosure of the dilated vessel. Percutaneous coronary stenting is reported with the same codes as PTCA in addition to the following codes: 

•36.06 or 36.07 â€“ insertion of stent. Code 36.06 is reported for non-drug-eluting stents and 36.07 is reported for drug-eluting stents. Note that drug coated (i.e., heparin coated) stents are reported with code 36.06. 
•00.45-00.48 â€“ number of stents Coronary artery bypass grafting (CABG) is a more invasive procedure where grafted vessels are used to bypass the coronary artery obstructions. When coding for CABG, use the following codes: 

•36.11-36.14 â€“ use the correct code from this range to identify the number of aortocoronary bypass grafts. 
AND/OR 
•36.15-36.16 â€“ use the correct code from this range to identify the number of internal mammary-coronary artery bypass grafts. 
AND/OR 
•36.17 â€“ use when an abdominal-coronary artery bypass is performed (i.e., gastric artery) 
AND/OR 
•36.19 â€“ use when coronary artery bypass is performed with vessels other than coronary, internal mammary, or abdominal. 
AND 
•39.61 â€“ extracorporeal circulation (i.e., cardiopulmonary bypass), if performed 
•00.16 â€“ pressurized treatment of venous bypass graft with pharmaceutical substance, if performed.

May you find this info helpful.


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## KellyLR (Jul 21, 2010)

*CAD Coding 2*

I forgot to mention about the documentation.  Less is more sometimes and you probably need to empower the doc about lean documentation skills.  I realize that documenting for CAD and blocked valves, arteries etc. can be time consuming but you can help the doc by researching what the Payors require for their documentation and maybe research it online at one of the specialties and see if someone posted some info that you can use.

Good Luck!


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## theresa.dix@tennova.com (Jul 23, 2010)

One thing i would question is. If the patient has a history of coronary artery disease and is dx'd with CAD, I would not think that is an automatic 414.02 dx. Unless the physician documents which vessel is diseased you shouldnt assumed it is the graft.


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