Cardiology Coding Alert

Create tools to capture the specific type of chest pain.

When you begin using ICD-10 codes in 2013, be sure to keep an eye out for chances to use a combination code -- meaning a single code that covers more than one diagnosis. Below is an example of how ICD-10 combines your coding for native coronary atherosclerosis and angina pectoris.

ICD-9-CM code:

• 414.01, Coronary atherosclerosis of native coronary artery

ICD-10-CM codes:

• I25.10, Atherosclerotic heart disease of native coronary artery without angina pectoris
• I25.110, Atherosclerotic heart disease of native coronary artery with unstable angina pectoris
• I25.111, Atherosclerotic heart disease of native coronary artery with angina pectoris with documented spasm
• I25.118, Atherosclerotic heart disease of native coronary artery with other forms of angina pectoris
• I25.119, Atherosclerotic heart disease of native coronary artery with unspecified angina pectoris

Diagnosis terms: Atherosclerosis is a type of arteriosclerosis (hardening of the arteries), characterized by plaque deposits. The reference to "native coronary artery" indicates the code(s) aren't appropriate for bypass graft atherosclerosis. Angina pectoris refers to chest pain or discomfort caused by coronary heart disease.

ICD-9 coding rules: Under ICD-9, you should report 414.2 (Chronic total occlusion of coronary artery) in addition to 414.01 if the patient also has chronic total occlusion of a coronary artery.

ICD-10 changes: The major change the ICD-10 codes will bring is that they differ based on "without" (I25.10) and "with" (I25.11-) angina pectoris.

Like ICD-9, ICD-10 rules indicate you should report an additional code (I25.82) if the patient also has chronic total occlusion of a coronary artery. Additionally, if the patient has coronary atherosclerosis due to lipid rich plaque, you should add I25.83. For codes in the range for ischemic heart diseases (I20- I25), you should use an additional code to identify presence of hypertension (I10-I15).

Documentation: Let clinicians know that the presence of angina pectoris will change your native coronary artery disease coding. They should be specific about whether the angina pectoris is unstable, with documented spasm, or another form. Documentation should also reveal whether the patient has chronichypertension, total coronary occlusion, and/or coronary atherosclerosis caused by lipid rich plaque.

Coder tips: Revise your coding tools to make it clear that ICD-10 offers a combination code for coronary atherosclerosis with angina pectoris. And make a note that I25.10, the "without angina pectoris" code, is appropriate for "Atherosclerotic heart disease NOS."