Cardiology Coding Alert

But ICD-10 notes let you know this is the best option once 429.2 is obsolete.

Part of ICD-10 preparation is improving documentation so it matches this highly specific code set. But you still may face cases where the documentation leaves you no choice but to apply an "unspecified" code. If you find yourself with nothing more to work with than "atherosclerotic cardiovascular disease," you turn to 429.2 in ICD-9. Here’s what to do when ICD-10 is implemented in 2014.

ICD-9-CM code:

429.2, Cardiovascular disease unspecified

ICD-10-CM code:

I25.10, Atherosclerotic heart disease of native coronary artery without angina pectoris

Cardiovascular disease is a broad term for heart and blood vessel disease often with problems related to atherosclerosis (plaque build-up in the arteries).

ICD-9 coding rules: Code 429.2 applies to arteriosclerotic cardiovascular disease (ASCVD) and cardiovascular arteriosclerosis. The code also applies to cardiovascular degeneration, disease, and sclerosis. When documentation indicates the presence of arteriosclerosis, you should use an additional code for the arteriosclerosis.

If the cardiovascular disease is due to hypertension, you should look to 402.x (Hypertensive heart disease) instead of 429.2.

ICD-10 changes: Code I25.10’s definition does not include the term "unspecified" the way 429.2’s does, and it features phrases such as "native coronary artery" and "without angina pectoris." But a note with I25.10 states it’s appropriate for "Atherosclerotic heart disease NOS." NOS means "not otherwise specified," which for coding purposes is the same as "unspecified." Consequently, I25.10 is an approximate match to 429.2, but you should check the ICD-10 index and tabular list to see if another code is more appropriate for your particular case.

To understand proper use of I25.10, be sure to review the notes that apply to the full I25.1- range. The codes apply to atherosclerotic heart disease of a native coronary artery, atherosclerotic cardiovascular disease, coronary (artery) atheroma, coronary (artery) atherosclerosis, coronary (artery) disease, and coronary (artery) sclerosis.

You should use an additional code, if applicable, to identify coronary atherosclerosis due to calcified coronary lesion (I25.84) or coronary atherosclerosis due to lipid rich plaque (I25.83).

Range I25.1- excludes atheroembolism (I75.-) and atherosclerosis of coronary artery bypass graft(s) and transplanted heart (I25.7-).

Documentation: Because I25.10 includes atherosclerotic heart disease NOS, this will be your default code when the physician’s documentation isn’t detailed enough for you to choose a more specific code. To help ensure you can choose the most specific code in the range, make it simple for the physician to document whether the disease is a native coronary artery and whether the patient suffers from angina pectoris. Your code options differ additionally based on whether the angina is unstable, has documented spasm, takes another form, or is unspecified.

Coder tips: Code 429.2 isn’t the only code the General Equivalency Mappings (GEMs) cross to I25.10. Code 414.01 (Coronary atherosclerosis of native coronary artery) also crosses to I25.10.

Remember: CMS has finalized the ICD-10 compliance date of Oct. 1, 2014. When ICD-10 goes into effect, you should apply the code set and official guidelines in effect for the date of service reported. Learn more at www.cms.gov/ICD10/ and www.cdc.gov/nchs/icd/icd10cm.htm#10update.