Medicare Compliance & Reimbursement

Hint: You must know if the patient also has angina pectoris or not.

Coding for atherosclerosis can be complicated. ICD-10-CM offers many different codes to choose from, and you must know specific details such as which artery is affected, what kind of atherosclerosis the patient has, and any associated complications the patient has experienced.

Not knowing these details could result in picking the wrong code, which will end up in denials.

Take a look at all you need to know to keep your atherosclerosis coding in tip-top shape.

Dive Into Atherosclerosis Definition

With atherosclerosis, the walls of the arteries lose a lot of their flexibility and elasticity, and they get deposits in them that slowly narrows their vasculature, says Tyler Griffeth, CPC, CPRC, coding consultant at Intermountain Healthcare. “That’s a big problem because we need blood for our cells to live.”

Keep an eye out for these terms: If you see the terms “atherosclerosis” and “arteriosclerosis” used interchangeably in medical documentation, don’t despair. Arteriosclerosis is the stiffening or hardening of the artery walls. Atherosclerosis is a specific type of arteriosclerosis; it affects the lumen or the inside wall of the arteries due to plaque buildup such as cholesterol.

You may also see coronary artery disease (CAD), which occurs when atherosclerosis causes a buildup of plaque in the arteries in or leading to the heart. CAD is commonly referred to as atherosclerotic heart disease or arteriosclerosis. Coronary atherosclerosis results from an accumulation of fatty and fibrous tissues within the coronary blood vessels. Over time, these accumulations calcify, which is why this condition is commonly referred to as “hardening of the arteries.”

Navigate the Many Atherosclerosis ICD-10-CM Choices

ICD-10-CM offers numerous codes for atherosclerosis. You will choose the appropriate code based on the artery affected, the anatomical site, laterality, and complications identified in the documentation.

For example, if the patient has atherosclerosis of the native coronary artery without angina pectoris, report I25.10 (Atherosclerotic heart disease of native coronary artery without angina pectoris). On the other hand, if the patient has atherosclerosis of the native coronary artery with unstable angina pectoris, report I25.110 (… with unstable angina pectoris).

If the documentation specifies atherosclerosis of the autologous vein coronary artery bypass graft(s) with unstable angina pectoris, report I25.710 (Atherosclerosis of autologous vein coronary artery bypass graft(s) with unstable angina pectoris). On the other hand, if the patient has atherosclerosis of the autologous artery coronary artery bypass graft(s) with unstable angina pectoris, report I25.720 (Atherosclerosis of autologous artery coronary artery bypass graft(s) with unstable angina pectoris).

When the documentation states that the patient has atherosclerosis of nonautologous biological coronary artery bypass graft(s) with unstable angina pectoris, you’ll report I25.730 (Atherosclerosis of nonautologous biological coronary artery bypass graft(s) with unstable angina pectoris).

You have even more choices when the patient has a transplanted heart. For example, assign I25.750 (Atherosclerosis of native coronary artery of transplanted heart with unstable angina) when the patient has atherosclerosis of the native coronary artery of a transplanted heart with unstable angina.