Cardiology Coding Alert

Question: I'm uncertain about when I should report 414.00 versus 414.01. What's the difference?

Montana Subscriber

Answer: You should only use 414.00 (Coronary atherosclerosis; of unspecified type of vessel, native or graft) if your documentation shows that the patient has obstructive coronary artery disease (CAD) involving coronary vessels but the documentation doesn't specify the location of the obstruction: native coronary artery or a bypass conduit.

Example 1: A patient presents to your cardiologist having had a coronary artery bypass graft (CABG). The cardiologist documents the patient as currently having CAD but does not specify if the CAD is of a native vessel or bypass graft. In this instance, the physician really did fail to specify which type of artery has the CAD when he probably should have. When the physician didn't specify and you have documentation that the patient has more than just native arteries, you should use 414.00.

Example 2: Your cardiologist documents "Patient admitted with CAD and unstable angina" but does not include information about the location. In this situation, you should also code CAD first using 414.00, because this is the reason for the unstable angina (411.1), which you can report as a secondary diagnosis.

On the other hand, if the cardiologist's documentation tells you that the CAD is of a native coronary artery and the patient is not a heart transplant patient, you should choose 414.01 (Coronary atherosclerosis; of native coronary artery). You should also report this code in two other circumstances:

 • if the patient has CAD and the cardiologist documents that she has no history of a prior CABG; and
 • if the patient had a prior percutaneous transluminal coronary angioplasty (PTCA) of a native artery and the cardiologist admits her with reocclusion of this lesion.

Important: If the documentation is unclear concerning prior bypass surgery and the location of the CAD, you should check with your cardiologist. After pestering him enough times and explaining that this information is necessary for billing purposes, your cardiologist will probably start documenting the location of the CAD.

Example: Your cardiologist admits a CAD patient with angina. On a previous admission, the patient underwent PTCA to a branch of the right coronary artery. During this admission, the cardiologist performs a cardiac catheterization, which identifies that the same vessel has reoccluded. In this situation, you should report 414.01 for the atherosclerosis of the coronary artery. You would also include the secondary diagnosis 413.9 (Angina pectoris; other and unspecified angina pectoris).