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CAD, NSTEMI and ACS

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I am needing to know the correct diagnosis coding for this scenario: Patient presents with chest pain. A heart cath is done with stenting of one artery. Final diagnosis is CAD (native), NSTEMI and ACS. One coder in our facility says that, along with the I21.4 for the NSTEMI, the CAD must be coded with unstable angina pectoris (I25.110) due to the diagnosis of ACS and patient having chest pain.
The opposing opinion is that the NSTEMI (I21.4) would be coded with I25.10 for the CAD without angina. It is the understanding of this coder that unstable angina is a lower complexity classification of ACS and the NSTEMI is another classification, as is STEMI. This particular patient did have a high troponin and the provider did not, at any time, document angina.
Any expertise would be greatly appreciated.
 

mitchellde

True Blue
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Columbia, MO
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A coder cannot assume one diagnosis will lead to or imply another. \you have documented NSTEMI, CAD, ACS. In addition you state that angina was at no time documented. so I would code
I21.4 =NSTENI
I25.10 = CAD
I24.9 = ACS
 
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