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Coding of CAD

Lesvia Posted Wed 02nd of January, 2013 14:18:14 PM

Based on the documentation for the following 2 scenarios, can you please tell us the correct ICD-9-CM code for the CAD? Please site reference material used. Thank you !

Scenario #1
Physician documents:
Past Medical History:
CAD: coronary artery disease with a three-vessel CABG previously.

Impression/Plan:
CAD: Native vessel. We will continue current medical therapy.

Scenario #2:
Physician documents:
Past Medical History:
CAD: Anterior MI, Occluded LAD (cath)- 1983, Inferior MI (cath medical therapy, stent: RCA)- 2005

Impression/Plan:
CAD, Native Vessel: assymptomatic. This condition is stable. The patient is tolerating medical therapy.

SuperCoder Answered Fri 04th of January, 2013 20:42:01 PM

In both scenarios, the physician specifies the CAD is in a native vessel. So you should report 414.01 for the CAD in both cases.
Here’s an excerpt from AHA’s Coding Clinic (2004, Vol. 21, No. 1). Key info is in caps:
Coronary Atherosclerosis Status Post CABG
… According to Coding Clinic Second Quarter 1995, page 17, and Third Quarter 1997, page 15, code 414.01 IS ASSIGNED WHEN the medical record documentation does not indicate that the patient has a history of prior coronary artery bypass surgery or THE PHYSICIAN HAS DOCUMENTED THE PRESENCE OF ATHEROSCLEROSIS IN A NATIVE CORONARY ARTERY.
And as a source indicating 414.01 is appropriate for CAD, consider this Coding Clinic excerpt from 2001, Vol. 18, No. 3:
Coronary Artery Disease and Ischemic Cardiomyopathy
Question:
The patient is a 61-year-old female, who has a history of coronary artery disease (CAD) in the past with remote myocardial infarction. In 1994, she underwent a cardiac catheterization, which showed a distal occlusion of the right coronary artery (RCA) and left anterior descending (LAD). She was not a candidate for revascularization at that time. The patient was hospitalized at our facility and discharged with the diagnosis of known CAD and ischemic cardiomyopathy. How should this diagnostic statement be coded? Would it be appropriate to assign both 414.8 and 414.01 based on the findings from the previous cardiac catheterization, although the index leads to code 414.9 for CAD?

Answer:
Assign code 414.8, Other specified forms of chronic ischemic heart disease, as principal diagnosis and code 414.01, Coronary atherosclerosis, Of native coronary artery, as an additional diagnosis. Both codes are needed to fully capture this diagnostic statement.

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