Answer These Questions to Pinpoint the Correct Coronary Atherosclerosis Code

I25 coronary atherosclerosis

About a month ago, yet another report came out about whether omega-3 supplements make a difference in cardiovascular disease risk. The findings of this particular meta-analysis were that supplementation may not reduce coronary heart disease in people at high risk of the disease and more study is needed. But while the research continues, plenty of cardiology patients are presenting for treatment of cardiovascular disease, meaning you need to know how to code it. Here are three questions to ask to get you to the correct code for coronary atherosclerosis of a native coronary artery.

1. What Kind of Vessel Is Involved, and Is Angina Documented?

Did you notice that I specified native coronary artery in the introduction? That’s because under I25.- (Ischemic heart disease) the ICD-10-CM code set provides distinct codes for atherosclerotic heart disease of native coronary arteries. You also need to know early in your decision-making process whether there is documentation of angina pectoris:

  • Native coronary artery without angina: I25.10 (Atherosclerotic heart disease of native coronary artery without angina pectoris)
    • Tip: Code I25.10 is appropriate for atherosclerotic heart disease NOS.
  • Native coronary artery with angina: I25.11- (Atherosclerotic heart disease of native coronary artery with angina pectoris).

The reason those I25.1- codes specify native coronary artery is that there are separate options when coronary artery bypass grafts and arteries of a transplanted heart are involved:

  • CABG/transplanted heart, without angina: I25.81- (Atherosclerosis of other coronary vessels without angina pectoris)
  • CABG/transplanted heart, with angina: I25.7- (Atherosclerosis of coronary artery bypass graft(s) and coronary artery of transplanted heart with angina pectoris).

Tip: An Excludes2 note under I25.1- points you to I25.7- for “atherosclerosis of coronary artery bypass graft(s) and transplanted heart.” But don’t forget to check I25.81- for those diagnoses when there is no documentation of angina.

2. If Angina Is Present, What Kind?

Within I25.11-, the code set provides four reportable codes for atherosclerosis based on the documentation for angina:

  • Unstable: I25.110 (Atherosclerotic heart disease of native coronary artery with unstable angina pectoris)
  • With spasm: I25.111 (Atherosclerotic heart disease of native coronary artery with angina pectoris with documented spasm)
  • Other forms: I25.118 (Atherosclerotic heart disease of native coronary artery with other forms of angina pectoris)
  • Unspecified: I25.119 (Atherosclerotic heart disease of native coronary artery with unspecified angina pectoris)
    • Notes with I25.119 let you know it’s the code to use for these conditions:
      • Atherosclerotic heart disease with angina NOS
      • Atherosclerotic heart disease with ischemic chest pain.

3. Is the Cause Documented?

When you’re reviewing the medical record, watch for whether the provider documented that the atherosclerosis is due to something specific. There is a “use additional code” note that applies to all codes in I25.1-, I25.7-, and I25.81-. It tells you to use an additional code to identify coronary atherosclerosis due to calcified coronary lesion (I25.84) or due to lipid rich plaque (I25.83).

What About You?

When you have so many codes to choose from, do you work from a list or from some sort of tool like a decision tree?

About 

Deborah works on a wide range of TCI SuperCoder projects, researching and writing about coding, as well as assisting with data updates and tool development for our online coding solutions. Since joining TCI in 2004, she’s covered the ins and outs of coding for radiology, cardiology, oncology and hematology, orthopedics, audiology, and more.

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