Coding corner: Accurate medical coding of angina

This is part of an ongoing series of coding tips to help ensure proper documentation.

Angina is pain or discomfort that occurs when your heart doesn’t get enough oxygen. Over time, the coronary arteries that supply blood to your heart can become clogged with plaque. If one or more arteries are partially clogged, not enough blood flows through and can cause chest pain.

Angina is usually an early manifestation of ischemic heart disease known as coronary heart disease, also called coronary artery disease.

Documentation in the medical record must be specific and clear to properly code the condition. Chest pain or abdominal pain are classified as symptoms and are only acceptable for reporting purposes when the provider has not established a confirmed diagnosis.

Often health care providers will document coronary artery disease, the most common heart disease. Even though angina is associated with coronary artery disease, it’s not specific enough for documentation purposes. Therefore, if a patient is diagnosed with angina, you should document the specific type of angina.

Types of angina

• Stable angina (ICD9-CM code 413.9)
• Can occur during physical activity or emotional stress
• Unstable angina (ICD9-CM code 411.1)
• Can occur with or without physical activity, even while at rest or sleeping
• Occurs when plaque in one or more coronary artery ruptures and if the buildup happens rapidly, there’s risk for a heart attack
• Variant angina (Prinzmetal’s angina; ICD9-CM code 413.1)
• A rare type that happens without warning
• Caused by a spasm in a coronary artery in which the artery narrows, reducing blood flow to the heart and causing chest pain
• Microvascular angina (Other and unspecified angina pectoris; ICD9-CM code 413.9)
• Can be a more severe type that lasts longer; the pain is caused by spasms within the walls of small arterial blood vessels

Men and women may experience different symptoms that can vary depending on the type of angina.

Elderly people may experience different symptoms of angina, and these can be easily overlooked. For example:

• Indigestion after meals may be blamed on a stomach ulcer.
• Pain in the back and shoulders may be diagnosed as arthritis.

Keep in mind that dementia can play a role in a person’s ability to communicate the pain they are experiencing.

In summary, it’s important to include specific documentation that angina exists at the time of the patient encounter, and that this diagnosis requires or affects care treatment or management.

For more information about this coding process, contact your provider consultant.

Did you know? ... According to the American Heart Association, heart disease is the No. 1 killer of women, affecting one out of three in the U.S. Women sometimes don’t understand the risks, and this puts them at additional risk for a heart attack.

None of the information included in this article is intended to be legal advice and, as such, it remains the provider’s responsibility to ensure that all coding and documentation are done in accordance with applicable state and federal laws and regulations.