Cardiology Coding Alert

ICD-10-CM:

Identify Location, Site, Complications to Choose Correct Atherosclerosis Dx

Published on Mon Aug 26, 2024

Hint: You must know if the patient also has angina pectoris or not.

Coding for atherosclerosis can be complicated. ICD-10-CM offers many different codes to choose from, and you must know specific details such as which artery is affected, what kind of atherosclerosis the patient has, and any associated complications the patient has experienced. Not knowing these details could result in picking the wrong code, which will end up in denials.

Take a look at all you need to know to keep your atherosclerosis coding in tip-top shape.

Dive Into Atherosclerosis Definition

With atherosclerosis, the walls of the arteries lose a lot of their flexibility and elasticity, and they get deposits in them that slowly narrows their vasculature, says Tyler Griffeth, CPC, CPRC, coding consultant at Intermountain Healthcare. “That’s a big problem because we need blood for our cells to live.”

Keep an eye out for these terms: If you see the terms “atherosclerosis” and “arteriosclerosis” used interchangeably in medical documentation, don’t despair. Arteriosclerosis is the stiffening or hardening of the artery walls. Atherosclerosis is a specific type of arteriosclerosis; it affects the lumen or the inside wall of the arteries due to plaque buildup such as cholesterol.

You may also see coronary artery disease (CAD), which occurs when atherosclerosis causes a buildup of plaque in the arteries in or leading to the heart. CAD is commonly referred to as atherosclerotic heart disease or arteriosclerosis. Coronary atherosclerosis results from an accumulation of fatty and fibrous tissues within the coronary blood vessels. Over time, these accumulations calcify, which is why this condition is commonly referred to as “hardening of the arteries.”

Navigate the Many Atherosclerosis ICD-10-CM Choices

ICD-10-CM offers numerous codes for atherosclerosis. You will choose the appropriate code based on the artery affected, the anatomical site, laterality, and complications identified in the documentation.

For example, if the patient has atherosclerosis of the native coronary artery without angina pectoris, report I25.10 (Atherosclerotic heart disease of native coronary artery without angina pectoris). On the other hand, if the patient has atherosclerosis of the native coronary artery with unstable angina pectoris, report I25.110 (… with unstable angina pectoris).

If the documentation specifies atherosclerosis of the autologous vein coronary artery bypass graft(s) with unstable angina pectoris, report I25.710 (Atherosclerosis of autologous vein coronary artery bypass graft(s) with unstable angina pectoris). On the other hand, if the patient has atherosclerosis of the autologous artery coronary artery bypass graft(s) with unstable angina pectoris, report I25.720 (Atherosclerosis of autologous artery coronary artery bypass graft(s) with unstable angina pectoris).

When the documentation states that the patient has atherosclerosis of nonautologous biological coronary artery bypass graft(s) with unstable angina pectoris, you’ll report I25.730 (Atherosclerosis of nonautologous biological coronary artery bypass graft(s) with unstable angina pectoris).

You have even more choices when the patient has a transplanted heart. For example, assign I25.750 (Atherosclerosis of native coronary artery of transplanted heart with unstable angina) when the patient has atherosclerosis of the native coronary artery of a transplanted heart with unstable angina.

And, report I25.760 (Atherosclerosis of bypass graft of coronary artery of transplanted heart with unstable angina) when the patient has atherosclerosis of bypass graft of coronary artery of transplanted heart with unstable angina.

For bypass grafts, report I25.790 (Atherosclerosis of other coronary artery bypass graft(s) with unstable angina pectoris) for atherosclerosis of other coronary artery bypass graft(s) with unstable angina pectoris and I25.810 (Atherosclerosis of coronary artery bypass graft(s) without angina pectoris) for atherosclerosis of coronary artery bypass graft(s) without angina pectoris.

Hone These Documentation Smarts

Complete documentation is vital when reporting atherosclerosis. Follow these handy tips to make sure you always choose the appropriate code from the myriad of options:

Tip 1: Determine the type of atherosclerosis, which should be properly documented. If the medical record does not specify the type of atherosclerosis, query the provider for clarification.

Tip 2: Confirm the specific area of the atherosclerosis — whether it is within the native artery or documented to be within the artery or vein graft.

Tip 3: Confirm if the patient also has angina pectoris and if so, what type. You must also know if the cardiologist mentions spasm.

Tip 4: For atherosclerosis of the extremities, the documentation must include the extremity affected, any associated pain, if there is ulceration or gangrene, and if it is a native artery or a graft.

Tip 5: For atherosclerosis of a coronary artery, the documentation must state if there is associated angina, if it is a native artery or a graft, etc.

Tip 6: When the patient has atherosclerotic heart disease of the native coronary artery, along with angina pectoris, use an appropriate combination code from I25.110 through I25.119 (Atherosclerotic heart disease of native coronary artery with unspecified angina pectoris). Do not code the angina and CAD separately.

“Don’t forget the ‘use additional’ codes such as I25.82 (Chronic total occlusion of coronary artery), I25.83 (Coronary atherosclerosis due to lipid rich plaque), I25.84 (Coronary atherosclerosis due to calcified coronary lesion), and other related risk factors such as Z77.22 (Exposure to environmental tobacco smoke), and Z72.0 (Tobacco use), when the documentation supports them,” says Robin Peterson, CPC, CPMA, senior consultant; compliance review, education, and training, Pinnacle Enterprise Risk Consulting Services in Centennial, Colorado.