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ICD-10 Guide
ICD-10 CodesI25.811

I25.811

Billable

Atherosclerosis of native coronary artery of transplanted heart without angina pectoris

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/06/2025

Code Description

ICD-10 I25.811 is a billable code used to indicate a diagnosis of atherosclerosis of native coronary artery of transplanted heart without angina pectoris.

Key Diagnostic Point:

I25.811 refers to atherosclerosis of the native coronary artery of a transplanted heart without angina pectoris. This condition arises when there is a buildup of plaque within the coronary arteries that supply blood to the heart muscle of a transplanted organ. The clinical presentation may vary, but it often includes asymptomatic phases, as patients may not exhibit angina pectoris. The anatomy involved includes the coronary arteries that originate from the aorta and supply blood to the heart muscle. Disease progression can lead to significant ischemic heart disease, heart failure, or even myocardial infarction if not monitored and managed appropriately. Diagnostic considerations include imaging studies such as coronary angiography, which can reveal the extent of atherosclerotic changes. Regular follow-up and monitoring are crucial in post-transplant patients to detect any signs of graft dysfunction or coronary artery disease early on.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires understanding of post-transplant complications and atherosclerosis.
  • Treatment complexity: Management may involve medication, lifestyle changes, and possibly revascularization procedures.
  • Documentation requirements: Detailed clinical documentation is necessary to support the diagnosis and treatment plan.
  • Coding specificity: Requires precise coding to differentiate from other forms of coronary artery disease.

Audit Risk Factors

  • Common coding errors: Misclassification of the type of coronary artery disease.
  • Documentation gaps: Incomplete records regarding the patient's transplant history and current symptoms.
  • Billing challenges: Potential denials if the documentation does not clearly support the diagnosis.

Specialty Focus

Medical Specialties

Cardiology

Documentation Requirements

Standard ICD-10-CM documentation requirements apply

Common Clinical Scenarios

Various clinical presentations within this specialty area

Billing Considerations

Follow specialty-specific billing guidelines

Transplant Surgery

Documentation Requirements

Standard ICD-10-CM documentation requirements apply

Common Clinical Scenarios

Various clinical presentations within this specialty area

Billing Considerations

Follow specialty-specific billing guidelines

Related ICD-10 Codes

Related CPT Codes

CPT Code

Clinical Scenario

Documentation Requirements

CPT Code

Clinical Scenario

Documentation Requirements

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The clinical significance of I25.811 lies in its association with increased morbidity and mortality in post-transplant patients. Atherosclerosis can lead to serious complications, impacting population health by increasing the burden on healthcare systems. Quality measures may include monitoring for cardiovascular events and ensuring appropriate follow-up care. Understanding the epidemiology of this condition is crucial for improving healthcare utilization patterns and outcomes in heart transplant recipients.

ICD-9 vs ICD-10

The clinical significance of I25.811 lies in its association with increased morbidity and mortality in post-transplant patients. Atherosclerosis can lead to serious complications, impacting population health by increasing the burden on healthcare systems. Quality measures may include monitoring for cardiovascular events and ensuring appropriate follow-up care. Understanding the epidemiology of this condition is crucial for improving healthcare utilization patterns and outcomes in heart transplant recipients.

Reimbursement & Billing Impact

Reimbursement considerations may vary based on the payer, and common denials can occur if documentation does not clearly establish the medical necessity of the services provided. Coding best practices include ensuring that all relevant clinical information is captured and that the coding accurately reflects the patient's condition.

Resources

Clinical References

  • •
    ICD-10 Official Guidelines for I00-I99
  • •
    Clinical Documentation Requirements

Coding & Billing References

  • •
    ICD-10 Official Guidelines for I00-I99
  • •
    Clinical Documentation Requirements

Frequently Asked Questions

What specific conditions are covered by I25.811?

I25.811 specifically covers atherosclerosis affecting the native coronary arteries of a transplanted heart, without the presence of angina pectoris. This includes cases where the patient may experience other symptoms or be asymptomatic.

When should I25.811 be used instead of related codes?

I25.811 should be used when a patient has a documented diagnosis of atherosclerosis in the native coronary arteries of a transplanted heart without any episodes of angina. If angina is present, I25.810 would be more appropriate.

What documentation supports I25.811?

Documentation should include a detailed history of the patient's heart transplant, any symptoms experienced, results from diagnostic imaging, and a clear treatment plan that reflects the management of atherosclerosis.