Cardiology Coding Alert

The terms for angina pectoris seem to be endless (angina decubitus, prinzmetal angina, preinfarction angina, variant angina, crescendo angina, etc.). Coders who use 413.9 (other and unspecified angina pectoris) without searching for a more specific diagnosis are engaging in what is known as dumping (i.e., they code as unspecified without taking time to code to the highest level of specificity). Yet sometimes a code ending in .9 or listed other and unspecified is the only way to code, explains Sue Prophet, RRA, CCS, director of classification and coding for the Society of Clinical Coding at the American Health Information Management Association.

When is 413.9 considered a dump code and when is it an appropriate diagnostic code?

For example, a biller for Escandon and White in Wali, NJ writes: We have reviewed the coding manual and do realize 413.9 is classified as a non-specific code. But none of the other angina codes listed seem to fit our purposes. Does this mean we should avoid using 413.9 entirely?

No, Prophet says. It means that coders need to understand when this unspecified code is appropriate and what other diagnostic options are out there.

Code 413.9 is potentially a dump code, she explains. A code is considered a dump code when it is used exclusively by a physician or billing staff for every case with a given problem, when there are other more specific codes available, she says.

The key to selecting the appropriate diagnostic code is to learn first about the various types of anginathe medical condition as well as the common namesand then group them according to their associated diagnostic code as follows:

1. Crescendo angina, also called unstable, preinfarction, and progressive angina.

Crescendo gets it name from the musical term that means to play progressively louder and louder.

The pain comes on more often, or it is more severe, or it comes on with less effortsometimes all three, says Brendan Phibbs, MD, professor of the clinical medicine section of cardiology at the University of Arizona College of Medicine and author of The Human Heart: A Basic Guide to Heart Disease. A clot, which partly occludes the coronary artery, causes the crescendo to increase in symptoms until a myocardial infarction occurs. Its a life and death emergency, explains Phibbs.

If this is the case, youll need to look in the tabular index for angina, crescendo, which will refer you to 411.1 (acute and subacute forms of ischemic heart disease). Select the one with the correct fourth digit: 411.1 (intermediate coronary syndrome).

2. Classical angina, sometimes referred to as pectoris or stable or chronic stable.

Here the patient experiences a painful discomfortsometimes described by a heaviness, pressure or fullness in the chestsomewhere in the upper half of the body that comes on with exertion and is relieved by rest.

The primary cause of angina is the accumulation of cholesterol plaques on the inside walls of the arteries leading to the heart. This condition is known as arteriosclerosis with its resultant array of diseases known as coronary artery disease (CAD).

Note: Even if the underlying cause of the angina is later identified as coronary arteriosclerosis after further diagnostic procedures or treatment, you would still bill it as angina because outpatient coding conventions require the diagnosis, condition, problem, or other reason for the encounter to be used.

Youll find codes for classical angina under 413. Because this is a truncated code, youll need to use a fourth digit to specific the type.

Angina decubitus, or 413.0, occurs only when the patient is lying down.

Prinzmetal angina, or 413.1, is a rare type of angina, named after Myron Prinzmetal, an American cardiologist. It doesnt fit any of the typical angina patterns. The pain often comes on at rest, even though the patient doesnt feel any discomfort during exercise. It may waken the patient during the early morning hours, says Phibbs. (You may also see it termed variant angina.)

Unlike classical angina, which is caused by cholesterol blockage, Prinzmetal appears to be caused by spasm or constriction of a coronary arteryeither in diseased or normal vessels, he adds. An EKG recording during an episode would show a striking S-T elevation, Phibbs explains.

Then theres 413.9, other and unspecified angina pectoris. It is not just a dump code in the sense of being limited to unspecified forms of angina, explains Prophet. The description means that if it is any other kind of angina than that indicated by codes 413.0 and 413.1, 413.9 is the correct code.