Cardiology Coding Alert

Discover why you can report more than 1 CAD code for the patient If your cardiologist sees a patient with coronary artery disease (CAD) but doesn't identify the location of the disease, you should report 414.00 as the diagnosis, right? Wrong. Overuse of 414.00 is among the most common coding errors, according to the American Health Information Management Association (AHIMA). Avoid making this mistake by learning the difference between 414.00 and 414.01. Common Cause of CAD Is Atherosclerosis The most prevalent type of heart disease, CAD, occurs when the coronary arteries become narrowed or blocked, says Jerome Williams Jr., MD, FACC, a cardiologist with Mid Carolina Cardiology in Charlotte, N.C. The most common cause is atherosclerosis, a progressive buildup of plaque that allows less blood flow to the heart muscle, resulting in angina pectoris. Some of the many complications of obstructive CAD include angina pectoris, cardiomyopathy or weakened heart muscle, and possibly sudden death. Guideline: "The rule I have always been told on any type of atherosclerosis is you can only use the code (such as one for CAD) if you have documented a minimum of 30 percent stenosis," says Sandy Fuller, CPC, MCS-P, HIS supervisor and compliance officer at Cardiovascular Associates of East Texas. "If you give a patient with less than 30 percent stenosis the CAD diagnosis, you may cause problems when the patient tries to acquire insurance in the future." When you code for CAD, you'll look at the subcategory 414.0x. Determine the fifth-digit classification by: • the location of the disease (for instance, native vessel, bypass graft, etc.) • whether or not the CAD has occurred in a transplanted heart. Keep in mind: You may assign more than one code from the subcategory 414.0x. For instance, you might use more than one 414.0x code if the physician indicates that the patient has CAD involving more than one type of coronary artery and specifies which types. In addition, make sure you specify which coronary artery is diseased. Avoid 414.00 as a Catchall 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 CAD involving coronary artery bypass conduits but the cardiologist didn't specify the location of the obstruction. Example 1: A patient presents to your cardiologist having had a CABG. The cardiologist documents the patient as 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. Therefore, if you have documentation that the patient has more than just native arteries, you should use 414.00. [...]