Cracking the Code

Coding Atherosclerosis with Angina and Acute Myocardial Infarction

When coding medical diagnoses such as atherosclerotic coronary artery disease with angina pectoris and acute myocardial infarction (AMI), it is important to remember the instructions from the coding guidelines. When a patient is admitted for atherosclerotic heart disease with angina pectoris, coders should use a combination diagnosis code from subcategories I25.11, atherosclerotic heart disease of native artery with angina pectoris and I25.7, atherosclerosis of coronary artery bypass graft(s) and coronary artery of transplanted heart with angina pectoris. It is incorrect to report a separate, additional code for the angina. The guidelines assume a causal relationship with both atherosclerosis and angina pectoris unless the provider specifically states that the angina is due to another disorder.

When a patient is admitted for atherosclerotic coronary artery disease due to an AMI, then it is proper protocol to sequence the AMI before the coronary artery disease.

Q: A 37-year-old patient arrives to the ED with complaints of dyspnea on exertion and sharp chest pain and tightness. The physician performed a chest x-ray to determine the cause of the chest pain. In the final impression, the physician notates coronary artery disease with unstable angina. Final diagnoses: acute AMI due to CAD and unstable angina pectoris
A: I21.9, acute myocardial infarction, unspecified I25.110, atherosclerotic heart disease of native coronary artery with unstable angina pectoris
Reference: ICD-10-CM Official Guidelines for Coding and Reporting FY 2021 I.C.9.b.
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