More Precise ICD-9 Codes Key:
Tips to Avoid 'Dump' Codes When Billing for Angina
Published on Tue Jun 01, 1999
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 [...]
