Assume Causality Unless Otherwise Noted With Combination Codes I25.11-
Question: The provider documents the patient having atherosclerotic heart disease with angina pectoris. Since codes in category I25.11- mention both of these conditions, do I still need to code the angina pectoris separately? Texas Subscriber Answer: This is a situation where it’s important to look to the ICD-10-CM Official Guidelines. As you mention, the descriptor for codes in category I25.11- (Atherosclerotic heart disease of native coronary artery with angina pectoris) include both atherosclerotic heart disease and angina pectoris. In Section I.C.9.b, you can find guidance about the causal relationship between these conditions, and how that causality affects the reporting. The guidelines say: “When using one of these combination codes it is not necessary to use an additional code for angina pectoris. A causal relationship can be assumed in a patient with both atherosclerosis and angina pectoris, unless the documentation indicates the angina is due to something other than the atherosclerosis.” So, unless the provider’s documentation says otherwise regarding the cause of the angina, you should be good to go with a combination code in the I25.11- family. Rachel Dorrell, MA, MS, CPC-A, CPPM, Production Editor, AAPC 
