ED Coding and Reimbursement Alert

Question: I’m reading an impression that notes atherosclerotic heart disease of the native coronary artery without angina pectoris. The patient also has coronary atherosclerosis due to a calcified coronary lesion. I’ve narrowed my code choices down to I25.10 or I25.84, but I’m not sure which code I should choose. Can you please help?

New York Subscriber

Answer: You should report both codes on your claim. You would first report I25.10 (Atherosclerotic heart disease of native coronary artery without angina pectoris), followed by I25.84 (Coronary atherosclerosis due to calcified coronary lesion).

A coding note under I25.10 tells you to “use an additional code if applicable to identify coronary atherosclerosis due to calcified coronary lesion (I25.84) or coronary atherosclerosis due to lipid rich plaque (I25.83).” In this case, the patient has coronary atherosclerosis due to calcified coronary lesion so you should report I25.84.

You would never report I25.84 alone on a claim. A coding note under I25.84 tells you to first code the coronary atherosclerosis, which can be found in categories I25.1- (Atherosclerotic heart disease of native coronary artery), I25.7- (Atherosclerosis of coronary artery bypass graft(s) and coronary artery of transplanted heart with angina pectoris), or I25.81- (Atherosclerosis of other coronary vessels without angina pectoris). In your case, I25.10 is the correct code for atherosclerotic heart disease of native coronary artery without angina pectoris. The “code first” note tells you the order in which the diagnosis codes should appear on your claim.