Question CAD with or without Angina

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I am looking for someone to help guide me to a better understanding of when it is appropriate to code I25.11 versus I25.10.

If a patient presents for a regular follow up and is being treated for CAD with the use of any of the mentioned (ASA, Plavix, Statins, beta blockers, calcium channel blockers) is it acceptable to code I25.11 or I25.118. Obviously if the patient is being treated with nitrates, we could potentially code the I25.11 but our physicians are questioning those that are being treated with other pharmacological agents and are "stable" and not presenting to the office that date of services with chest pain or other chest pain symptoms.

Any guidance would be appreciated. Thanks!
 

Munzueta

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Hello,

ok so we have guideline in Chapter 9 for CAD with angina. Any time a patient comes in with angina and CAD, a casual relationship can be assumed, meaning you would be able to use code I25.11X depending on the type of angina.

Now, from the scenario you are providing above, it seems you are trying to code angina based on medications being given without a proper diagnosis of angina. Yes angina is pretty much chest pain, but it does have to be specified as such since chest pain can be related to so many other factors (GERD, pneumonia, etc)

If a patient is being seen for CAD and is taking his home meds and that's all stated then code I25.10 will need to be used. We as coders cannot assume as we are not doctors and can't give a diagnosis.

hope this helps.
 
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