Cardiology Coding Alert

Hint: Make sure you know if the patient also has angina pectoris.

If you see the terms "atherosclerosis," "arteriosclerosis," or "coronary artery disease (CAD)" in the medical documentation, do you know which ICD-10 codes to turn to? With coronary arteries, your decision may be even more challenging because you have additional options based upon whether the cardiologist worked with a native artery, bypassed artery, or transplanted heart.

Read on to learn how you can conquer this tricky coding area - specifically in regards to atherosclerotic heart disease of the native coronary artery.

Define the Condition for Clarity

Before we dive into the ICD-10 codes you'll need to know, take a look at the following definitions to deepen your understanding:

• Arteriosclerosis - The stiffening or hardening of the artery walls.
• Atherosclerosis - A specific type of arteriosclerosis. Atherosclerosis affects the lumen or the inside wall of the arteries due to plaque buildup such as cholesterol, according to Carol Hodge, CPC, CCC, CEMC, certified medical coder of St. Joseph's Cardiology in Savannah, Georgia.
• CAD - When atherosclerosis causes a buildup of plaque in the arteries in or leading to the heart. "Coronary artery disease is commonly referred to as atherosclerotic heart disease or arteriosclerosis," says Hodge. "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.'"

"Many people use the terms 'atherosclerosis' and 'arteriosclerosis' interchangeably because essentially both are referring to the hardening of the arteries, says Mari Robinson, CPC, CPMA, CRC, CCC, compliance analyst of chronic conditions at Riverside Medical Group in Newport News, Virginia.

When you look up atherosclerosis in the ICD-10 index, a note tells you to "see also arteriosclerosis," Hodge adds.

Rely on I25- For Atherosclerosis Dx

When it comes to where to look in the ICD-10 manual for atherosclerosis of the coronary arteries, you should turn to I25- (Chronic ischemic heart disease).

Don't miss: Under I25-, the ICD-10 manual tells you to use an additional code to identify the following:

• I25.82 (Chronic total occlusion of coronary artery)
• Z77.22 (Contact with and (suspected) exposure to environmental tobacco smoke (acute) (chronic))
• Z87.891 (Personal history of nicotine dependence)
• Z57.31 (Occupational exposure to environmental tobacco smoke)
• F17- (Nicotine dependence)
• Z72.0 (Tobacco use).

Now, this is where it can get tricky because within I25.- you will need to know if the atherosclerosis is of the native coronary artery, bypassed artery, or a transplanted heart. Read on to learn what to do in the case of the native coronary artery.

Delve Into Atherosclerosis of Native Coronary Artery

For atherosclerosis of the native coronary artery, you will choose I25.1- (Atherosclerotic heart disease of native coronary artery). According to the ICD-10 manual, a fifth character is required on this code. Your options become even more focused as you identify whether the patient also had angina pectoris, which is characterized by chest pain and is common in patients with arteriosclerosis.

Don't miss: The ICD-10 manual lists included conditions for I25.1-, which are as follows:

• Atherosclerotic cardiovascular disease
• Coronary (artery) atheroma
• Coronary (artery) atherosclerosis
• Coronary (artery) disease
• Coronary (artery) sclerosis.

Caution: Also, according to the ICD-10 manual, you should use an additional code to identify the following:

• I25.83 (Coronary atherosclerosis due to lipid rich plaque)
• I25.84 (Coronary atherosclerosis due to calcified coronary lesion).

Reminder: Only report what is documented within the record, says Christina Neighbors, MA, CPC, CCC, Coding Quality Auditor for Conifer Health Solutions, Coding Quality & Education Department, and member of AAPC's Certified Cardiology Coder steering committee. The physician must state the correlation. Never assume.

The word "and" should be interpreted to mean either "and" or "or" when it appears in a title, Neighbors adds. The word "with" or "in" should be interpreted to mean "associated with" or "due to" when it appears in a code

title, the alphabetic index or an instructional note in the tabular list. The classification presumes a causal relationship between the two conditions linked by the terms in the alphabetic index or tabular list.

If the patient does not have angina pectoris, then you would choose: I25.10 (Atherosclerotic heart disease of native coronary artery without angina pectoris). Atherosclerotic heart disease (NOS) is an included condition for I25.10.

Angina Pectoris Present? Do This

If, however, the patient also experiences angina pectoris, you may look to I25.11- (Atherosclerotic heart disease of native coronary artery with angina pectoris). This code requires a sixth character, so your choices become even narrower. Check out the options:

• 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)
• I25.119 (Atherosclerotic heart disease of native coronary artery with unspecified angina pectoris). Included conditions for this code are: atherosclerotic heart disease with angina NOS and atherosclerotic heart disease with ischemic chest pain.

Don't miss: As you can see, it's important for the documentation to state if angina pectoris is present, and if it is present, then you must also pay attention to if the cardiologist mentions spasm, as well.

Caution: "The Official ICD 10 Guidelines for coding atherosclerosis or coronary artery disease with angina include a combination code for both," Robinson says. "The angina is not coded separately when both are documented as the patient's diagnosis or condition. The specific type of angina should be documented and is coded within the combination code for CAD with angina."

Challenges can arise when the cardiologist does not clearly indicate if the angina is acute or chronic and controlled with meds, Robinson adds.

Robinson shares some handy steps you can take to confirm coding a combination code for CAD with angina:

• Step 1: Query the provider to see if this is the final diagnosis.
• Step 2: If the cardiologist documents the medicine that stabilized the angina, code the angina with the CAD by using the appropriate combination code I25.1XX that represents the CAD with the type of angina. Example: You would report CAD with stable angina (controlled with medication) with I25.118.
• Step 3: Or, if the cardiologist discontinues the angina medicine, and the patient returns with symptoms of angina and the cardiologist documents the angina and/or the symptoms with the athero­sclerosis, report the combination code for CAD and angina for that date of service.