Q&A: Coding angina

Q: I understand what unstable angina is, but what’s stable angina? How is it coded? 

A: There are several codes related to angina within the code set. Let’s take a peek at the Tabular List and review each possible code:

• I20.0 Unstable Angina: Unexpected chest pain, often occurring at rest, sleeping, or accompanying minimal exertion. Rest or medication often does not provide relief. It often worsens and may lead to a myocardial infarction. Treatment often includes a cardiac catheter to diagnose the issue and provide intervention. It may be referred to as acute coronary syndrome (ACS) by providers.
• I20.1 Angina pectoris with documented spasm: This is sometimes referred to Prinzemetal angina. It’s demonstrated by a temporary discomfort or pain that is caused by a temporary spasm or constriction in one or more of coronary arteries. It usually happens in people aged 50 years or younger. Spasms can range from very minor to severe, and sometimes may completely block the coronary artery. A severe spasm which lasts more than 15 minutes can permanently damage the heart and lead to an acute myocardial infarction.
• I20.8 Other forms of angina: An inclusion term listed for this code is angina equivalent. This is defined as symptoms such as shortness of breath, diaphoresis, extreme fatigue, and pain in other sites besides the chest. These symptoms are attributed to myocardial ischemia. Documentation of stable angina will fall to this code.
• I20.9 angina pectoris, unspecified: This code is assigned when the documentation states angina, ischemic chest pain, or anginal syndrome.

We also have codes that link angina to coronary artery disease. The codes in this grouping (the I25 grouping) break down in the same pattern as the angina codes to include unstable, with spasms, other, and unspecified.

Finally, let’s talk about ACS. This maps to the code 124.9, which is acute ischemic heart disease, unspecified. Providers use this term to mean many different things and often this documentation requires a query to ensure you’re actually coding to the intent of the provider.

Talk to your providers (cardiologists) to better understand how they define these terms and to ensure they understand the implications of using these terms related to code assignment.

Editor’s Note: Laurie L. Prescott, RN, MSN, CCDS, CDIP, CRC, CDI education director at HCPro in Middleton, Massachusetts, answered this question. Contact her at lprescott@hcpro.com. For information regarding CDI Boot Camps visit www.hcprobootcamps.com/courses/10040/overview.