Cardiology Coding Alert

Don't be lax in coding the highest level of specificity If your cardiologist sees a patient with coronary artery disease (CAD) but doesn't identify the location of the disease, you should report 414.00 as the diagnosis, right? Wrong. Overuse of 414.00 is among the most common coding errors, according to the American Health Information Management Association (AHIMA). Avoid making this mistake by learning the difference between 414.00 and 414.01. Common Cause of CAD Is Atherosclerosis The most prevalent type of heart disease, CAD, occurs when the coronary arteries become narrowed or blocked, says Jerome Williams Jr., MD, FACC, a cardiologist with Mid Carolina Cardiology in Charlotte, N.C. The most common cause is atherosclerosis, a progressive buildup of plaque that allows less blood flow to the heart muscle, resulting in angina pectoris. Some of the many complications of obstructive CAD include angina pectoris, cardiomyopathy or weakened heart muscle, and possibly sudden death.

When you code for CAD, you'll look at the subcategory 414.0x and determine the fifth-digit classification by the location of the disease (e.g., native vessel, bypass graft, etc.) and by whether or not the CAD has occurred in a transplanted heart.

Keep in mind: You may assign more than one code from the subcategory 414.0x. "You might use more than one code from the 414.0x if the physician indicates that the patient has CAD involving more than one type of coronary artery and specify which types," says Greg Schnitzer, RN, CCS, CCS-P, CPC, CPC-H, RCC, CHC, product manager at CodeRyte Inc. In addition, make sure you specify which coronary artery is diseased. Avoid 414.00 as a Catchall You should only use 414.00 (Coronary atherosclerosis; of unspecified type of vessel, native or graft) if your documentation shows that the patient has obstructive CAD involving coronary artery bypass conduits but the cardiologist didn't specify the location of the obstruction.

Example 1: A patient presents to your cardiologist having had a CABG. The cardiologist documents the patient as having CAD but does not specify if the CAD is of a native vessel or bypass graft.

In this instance, "the physician really did fail to specify which type of artery has the CAD when he probably should have," Schnitzer says. "When the physician didn't specify and you have documentation that the patient has more than just native arteries, then you should use 414.00."

Example 2:  Your cardiologist documents "Patient admitted with CAD and unstable angina" but does not include information about the location. In this situation, you should also code CAD first using 414.00, because this is the reason for the unstable angina (411.1), which could be reported as a secondary diagnosis. 
 
Use 414.01 for Native Coronary Artery If the cardiologist's documentation tells you that [...]