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Home , Angina, Coronary artery disease

Volume 2, Issue 5, October 2015 Last Revised: April 2018

Risk Adjustment Coding Academy- Coding Focus

Narrowing down the options for coding Coronary

and exercising regularly, are advised in records must contain complete the treatment of CAD. , such documentation for those codes to be as ‐modifying drugs, , utilized. and ACE inhibitors, are also considered effective. When surgical intervention is ICD-10 Mapping needed, and placement may be recommended. In severe cases, The table below provides an ICD‐9 to ICD‐ coronary artery bypass graft (CABG) 10 crosswalk for CAD of native coronary sugery may be necessary. Since this is an artery with . open‐ procedure, it is often reserved for cases of multiple narrowed ICD-10 Mapping coronary .2 ICD-9 Code ICD-10 Code Coding Considerations According to the Centers for Disease 414.01 (no HCC)- I25.11_* In ICD‐9, code assignment for CAD is Coronary (HCC88)- Control and Prevention (CDC), Coronary of Atherosclerotic Artery Disease (CAD) is the most common primarily based on the type of artery: native coronary heart disease of type of heart disease in the . whether native or transplanted as a artery native coronary CAD is due to plaque buildup in the walls graft. 3 According to guidance in the artery with angina of the arteries that supply to the Coding Clinic, if a patient has no history of + pectoris heart (called ).1 Plaque prior CABG assign the code for native 4 413.9 (HCC 88)- *Sixth Digit: is made up of cholesterol deposits. Over artery, 414.01 (no HCC). If CABG is Angina pectoris, 0- time, the buildup of plaque causes the unknown, assign code 414.00 (no HCC). If unsp. 1- angina with inside of the arteries to narrow; a process angina pectoris is also documented, documented called atherosclerosis. assign the additional code 413.9 (HCC 8- other forms of 88). angina pectoris 9- unspecified Complications angina pectoris Documentation is Key in ICD-10 Excessive plaque buildup and narrowed artery walls can make it harder for blood ICD‐10 offers the ability to code anginal to flow through the body. When the complications of CAD with one 1 Centers for Disease Control and Prevention heart muscle does not get enough blood, combination code.5 A causal relationship website (accessed October 2015): it can cause chest or discomfort can be assumed if a patient has both http://www.cdc.gov/heartdisease (called angina). Angina is the most atherosclerosis and angina pectoris, /coronary_ad.htm common symptom of CAD. unless documentation indicates another 2 MayoClinic website: Coronary Artery Disease (accessed October 2015): cause for angina. mayoclinic.org CAD can also weaken the heart muscle 3 2012 Professional: International potentially leading to , a The correct code assignment of coronary Classification of , 9th revision, Clinical serious condition where the heart cannot atherosclerotic disease with anginal Modification. Eden Prairie, MN: OptumInsight. pump blood as it should. Additionally, an condition is based upon the type of 4 AHA Coding Clinic, 1995, Q2, “Clarification‐ irregular heartbeat (called ) coronary artery (native, bypass graft, and CAD native coronary artery‐ no Hx of prior may develop. whether or not it is of transplanted heart) CABG and the type of angina pectoris (unstable, 5 Anita Schmidt, K.K., &, P.W. (2016). ICD‐10‐ Treatment with documented spasm, other specified CM Expert for Physicians. Optum360 forms of angina, or unspecified). Since Lifestyle changes, such as quitting ICD‐10 allows for a greater degree of , eating healthy, losing weight specificity, this means that medical Coverage provided by Amerigroup, Inc. Reference the ICD-10-CM codebook, CMS-HCC Risk Adjustment Model V23, and AHA Coding Clinic for complete code sets and official coding guidance. It is not guaranteed that the information supplied is without defect. Any redistribution or other use is strictly forbidden. Y0014_16_29722_I_11/09/2016