Atherosclerotic Coronary Artery Disease and Angina

Atherosclerosis is termed as the hardening and narrowing of arteries due to the build-up of cholesterol and other material called plaque on their inner walls. This plaque may partially or totally block blood flow through arteries in the heart, brain, pelvis, legs, arms or kidneys. This can precipitate various conditions, including:

• Coronary heart disease (plaque in arteries in or leading to the heart)
• Angina (chest pain from reduced blood flow to the heart muscle)
• Carotid artery disease (plaque in neck arteries supplying blood to the brain)
• Peripheral artery disease (plaque in arteries of the extremities, especially the legs)

Atherosclerotic heart disease (ASHD):

Atherosclerosis within the coronary arteries is known in ICD-10-CM as atherosclerotic heart disease (ASHD). Other terms for this condition are:

• Coronary artery disease (CAD)
• Coronary (artery) atherosclerosis
• Atherosclerotic cardiovascular disease (ASCVD)

ICD-10-CM has combination codes for atherosclerotic heart disease with angina pectoris. These combination code selections are based on several factors which are described as below:

1. Vessel involvement:

ASHD is coded in ICD-10-CM according to the type of vessel(s) in which it occurs. The code categories would include: (Type of vessel is underlined in Italics.)

• I25.1 Atherosclerotic heart disease of native coronary artery
• I25.70 Atherosclerosis of coronary artery bypass graft(s), unspecified, with angina pectoris
• I25.71 Atherosclerosis of autologous vein coronary artery bypass graft(s) with angina pectoris)
• I25.72 Atherosclerosis of autologous artery coronary artery bypass graft(s) with angina pectoris
• I25.73 Atherosclerosis of nonautologous biological coronary artery bypass graft(s) with angina pectoris
• I25.75 Atherosclerosis of native coronary artery of transplanted heart with angina pectoris
• I25.76 Atherosclerosis of bypass graft of coronary artery of transplanted heart with angina pectoris
• I25.79 Atherosclerosis of other coronary artery bypass graft(s)with angina pectoris

2. Causal relationship between ASHD and Angina:

ICD-10-CM presumes a causal relationship between ASHD and angina. When both conditions are present, and no other cause of angina has been documented, a code from category I25 should be selected. The final digit indicates the presence or absence of angina, and angina type.

I25.10 Atherosclerotic heart disease of native coronary artery without angina pectoris

I25.11 Atherosclerotic heart disease of native coronary artery with angina pectoris

• I25.110 Atherosclerotic heart disease of native coronary artery with unstable angina pectoris
• I25.111 Atherosclerotic heart disease of native coronary artery with angina pectoris with documented spasm
• I25.118 Atherosclerotic heart disease of native coronary artery with other forms of angina pectoris

3. Type of Angina:

Unstable angina

• This Includes accelerated/crescendo angina

Angina pectoris with documented spasm

• Includes Variant/Prinzmetal angina
• Caused by spasms in the coronary arteries
• Often occurs at rest

Other forms of angina pectoris

• Includes stable angina/angina of effort
• Physical activity/stress can trigger
• Often gets better with rest, medicine

Angina pectoris, unspecified

4. Comorbid conditions:

Additional codes to identify the comorbid conditions, for example, hypertension, and tobacco use are also coded if documented in the medical record.

Table:

Happy learning! Happy Coding!

References:

https://www.cms.gov/medicare/coding/icd10/downloads/icd10clinicalconceptscardiology1.pdf

NA_CARE_ICD_10_CM_Documentation_Coding_for%20Cardiovascular_Diseases_ENG_8_2018.pdf