414.00 vs 414.01

dawn1170

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I am new to the cardiology scene and I have a question for the experts.

What code would you use for Coronary Artery Disease?

I am using 414.00 and the MD is using 414.01

Any help is greatly appreciated

Thanks,
Dawn
 

rthames052006

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I am new to the cardiology scene and I have a question for the experts.

What code would you use for Coronary Artery Disease?

I am using 414.00 and the MD is using 414.01

Any help is greatly appreciated

Thanks,
Dawn
Have you reviewed the narrative in both codes, what does his documentation state. Does it clearly state Native coronary artery or is he being non-specific and just saying CAD...

I would check his documentation carefully, the dx he is using is very specific and the one your using is unspecified.

Just a thought
 

dawn1170

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The MD only states CAD.

The MD is using the 414.01 on all of his CAD charts. There is nothing mentioned about native artery however; In the AHA coding clinic it states that if there is no history of a Graft being performed than 414.01 is to be used. I am soooo confused.

Thanks
Dawn
 

mcpalmeter

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Hi Dawn,

Native coronary arteries are those that the patient was born with - before any bypasses were performed with veins or arteries from other areas of the body.

Per AHIMA's Coding Clinic:
Assign code 414.00 if the documentation does not identify the coronary artery involved. Code 414.01 is assigned if the documentation specifies that the CAD is of a native coronary artery or if there is no history of a previous coronary artery bypass graft (CABG). Code 414.02 is assigned if the documentation indicates CAD of a bypass graft using the patients own vein and code 414.03 is assigned when the graft is not of the patient's own tissue. Code 414.04 is assigned when the CAD involves an artery (mammary, brachial, etc) used as a bypass graft. Code 414.05 is assigned when the CAD is of a bypass graft but the type of bypass graft is not identified. It is incorrect to assign a code from range 414.02-414.05, merely because a patient has had previous coronary artery bypass surgery. Query the physician if the documentation in the medical record is unclear as to which artery is involved.

Hope this helps. :eek:

-Maryann C. Palmeter, CPC
 

rthames052006

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Davistm

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This is a very helpful string. The links and other information provided was excellent; very useful. Thanks to all involved.
 

LindaTemp

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414.00 vs. 414.01

Coding Clinical originally addressed this topic in 1995; however they published further clarification in Third Quarter 1997 Coding Clinic which indicates that for a diagnosis of coronary artery disease, when there is no documentation of prior CABG, the appropriate code selection would be 414.01. The assumption is that the vessel is native, unless specifically stated that there was are also graft vessels present.

Linda Templeton, CCS-P, CPC, CPC-H
 

Ellacott

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I also use 414.01, even if it is not specified. The way it was explained to me was that the patient always have CAD in their native artery. If they had a bypass the CAD was not removed, it was just bypassed.
 

lori mitchell

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Cad

If the documentation just says "coronary artery disease", then you should use the unspecified code 414.00. You would only use 414.01 if the documentation clearly states that it is CAD of a native artery (i.e. "80% stenosis of the LAD", etc.). I would caution anyone about "assuming" that the CAD is of a native artery.
 

Lisa Bledsoe

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Lori - check out the link posted by rthames052006 on 4/12/08. It is accurate on how to code CAD. If it is unspecified, the correct code is 414.01. To use 414.00 would be to assume that the patient has had a graft.
Lisa
 

dmaec

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Actually, coders can only report code 414.00 (coronary Athersclerosis of Unspecified type of Vessel, Native or Graft) IF the documentation indicates that the patient DOES have a "non-native" coronary vessels from a CABG and that the physician DIDN'T specifiy where the CAD is in the patient. Two criteria must be met in order for us to use 414.00 - 1)the physician didn't document which type of artery has the disease and 2) there is documentation present that indicates that the patient actually has both native and non-native coronary arteries.
Coding Clinic for ICD-9-CM has a lot of info on this.
I agree with Lisa, I'd go with 414.01.
 

LindaTemp

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Coding Coronary Artery Disease

Here's the official coding rule from the second quarter, 1995 issue of Coding Clinic for ICD-9-CM:


Question: Is it appropriate to assign code 414.01, Coronary atherosclerosis, of native coronary artery, if the medical record documentation does not indicate that the patient has a history of prior coronary artery bypass surgery?

Answer: Assign code 414.01, Coronary atherosclerosis, of native coronary artery, if medical record documentation shows no history of prior coronary artery bypass. If the documentation is unclear concerning prior bypass surgery, query the physician.

Again, Third quarter, 1997 issue of Coding Clinic for ICD-9-CM:

Question: A patient has coronary artery disease. There is no mention of a past history of CABG. Should this be coded to 414.00, Coronary atherosclerosis of unspecified type of vessel, native or graft, or 414.01, Coronary atherosclerosis of native coronary artery?

Answer: Assign code 414.01, Coronary atherosclerosis of native coronary artery. Since there is no history of CABG, this is a native coronary vessel. However, if the documentation is unclear concerning prior bypass surgery, query the physician. This is consistent with advice previously published in Coding Clinic, second quarter 1995, page 17.

So, based on this guidance, it is correct to use 414.01 when the documentation states "coronary artery disease", and there is no documentation to indicate that the patient has anything other than native coronary arteries.
 

MacksMom

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Cad

I agree with Lori. Be cautious of which CAD diagnosis you use. If a doctor does not specify a coronary vessel (any of the 5 main coronary arteries or their branches) and also does not specify that the coronary artery disease is in a graft of a coronary artery, 414.00 should be used. If he mentions that a previously done bypass graft is occluded (has a stenosis) you would use 414.02 to specify that the stenosis is in the graft. If he mentions a particular coronary artery vessel (left anterior descending, left circumflex, right coronary artery, etc...) has an occlusion (stenosis) you can code 414.01. You can also code 414.01 if he mentions that the patient has had a previous stent placed in a particular coronary vessel and also if they've had a previous bypass surgery performed (those aren't done unless the patient has been diagnosed with 414.01 already). In order to code 414.2 the doctor would have to state in his documention that there is a "chronic" total occulsion of a coronary artery. That's important, because the patient can have a subtotal occlusion, a total occlusion, a chronic total occlusion. There is a difference. Those of you who code interventions know what I'm talking about. Even though the subtext under 414.2 says "complete" and "total" we don't use 414.2 unless the Doctor says "chronic". If anyone has anything that supports using 414.2 for anything other than chronic please share that here. Thanks.

Jenn Haney, CPC, CCC
 
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