Coding corner update: Improve medical record documentation for angina

Beginning Oct. 1, 2015, the transition to ICD-10-CM will affect every area of health care. Many codes contain much greater specificity. This article includes updated codes to align with the transition to ICD-10-CM.

Angina is pain or discomfort that occurs when your heart doesn’t get enough oxygen due to reduced blood flow. Over time, the coronary arteries that supply blood to your heart can become clogged with plaque. When plaque builds up in the heart’s arteries, the condition is called atherosclerosis. If one or more arteries are partly 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. According to the American Heart Association, heart disease is the number one killer of men and women, affecting one out of three in the U.S. Women sometimes don’t understand the risks, putting them more at risk for a heart attack.

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

In ICD-10-CM, a causal relationship can be assumed in a patient with both atherosclerosis and angina pectoris, unless the documentation indicates the angina is due to something other than the atherosclerosis. (Coding guideline I.C.9.b). If a patient is diagnosed with angina, you should document the specific type of angina.

Types of angina

• Stable angina (ICD-10-CM code I20.9, angina pectoris, unspecified)
• Can occur during physical activity or emotional stress

• Unstable angina (ICD-10-CM code I20.0, unstable angina)
• 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) (ICD-10-CM code I20.1, angina pectoris with documented spasm)
• A rare type of angina 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 (ICD-10-CM code I20.8, other forms of angina pectoris)
• Can be a more severe type of angina that lasts longer, and 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 or reflux.
• Pain in the back and shoulders may be interpreted by the patient or diagnosed as arthritis.

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

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 and management.

ICD-10-CM coding for all conditions should follow coding conventions, chapter specific guidelines and general coding guidelines.

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

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.