ICDxICD-10 Medical Coding

ICDxICD-10 Medical Coding

ICD-10 Guide

I25.11

Non-billable

Atherosclerotic heart disease of native coronary artery with angina pectoris

BILLABLE STATUSNo

IMPLEMENTATION DATEOctober 1, 2015

LAST UPDATED09/06/2025

Code Description

ICD-10 I25.11 is a used to indicate a diagnosis of atherosclerotic heart disease of native coronary artery with angina pectoris.

Key Diagnostic Point:

I25.11 refers to atherosclerotic heart disease of the native coronary artery accompanied by angina pectoris. This condition is characterized by the buildup of plaque within the coronary arteries, leading to reduced blood flow to the heart muscle. Clinically, patients may present with episodes of chest pain or discomfort, often triggered by physical exertion or emotional stress. The anatomy involved includes the coronary arteries, which supply blood to the heart. Disease progression can lead to chronic ischemia, heart failure, or myocardial infarction if left untreated. Diagnostic considerations include a thorough patient history, physical examination, and diagnostic tests such as electrocardiograms (ECGs), stress tests, and coronary angiography to assess the severity of arterial blockage. Management typically involves lifestyle modifications, pharmacotherapy (e.g., nitrates, beta-blockers, statins), and possibly interventional procedures like angioplasty or coronary artery bypass grafting (CABG).

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

Diagnostic complexity: Requires comprehensive evaluation of symptoms and diagnostic tests.
Treatment complexity: Involves a multidisciplinary approach including medication management and potential surgical interventions.
Documentation requirements: Detailed documentation of symptoms, diagnostic tests, and treatment plans is essential.
Coding specificity: Requires accurate coding to differentiate from other forms of heart disease.

Audit Risk Factors

Common coding errors: Misclassification of angina types or failure to document the presence of atherosclerosis.
Documentation gaps: Incomplete records regarding patient symptoms or treatment plans.
Billing challenges: Potential denials due to insufficient documentation or incorrect code selection.

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

Internal Medicine

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 CPT Codes

CPT Code

Clinical Scenario

Documentation Requirements

CPT Code

Clinical Scenario

Documentation Requirements

CPT Code

Clinical Scenario

Documentation Requirements

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

I25.11 has significant clinical implications as it represents a common cause of morbidity and mortality in the population. The prevalence of atherosclerotic heart disease is high, contributing to increased healthcare utilization and costs. Quality measures often focus on managing risk factors and improving patient outcomes. Understanding the epidemiology of this condition is crucial for public health initiatives aimed at reducing cardiovascular disease incidence.

ICD-9 vs ICD-10

I25.11 has significant clinical implications as it represents a common cause of morbidity and mortality in the population. The prevalence of atherosclerotic heart disease is high, contributing to increased healthcare utilization and costs. Quality measures often focus on managing risk factors and improving patient outcomes. Understanding the epidemiology of this condition is crucial for public health initiatives aimed at reducing cardiovascular disease incidence.

Reimbursement & Billing Impact

Reimbursement considerations include ensuring that the diagnosis is clearly linked to the services provided. Common denials may arise from insufficient documentation or failure to demonstrate medical necessity for treatments. Best practices include maintaining thorough records of patient interactions, diagnostic tests, and treatment plans to support claims.

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 I25.11?

I25.11 covers atherosclerotic heart disease of the native coronary artery specifically when the patient experiences angina pectoris. This includes stable angina, which is predictable and occurs with exertion, and unstable angina, which can occur at rest and is more severe.

When should I25.11 be used instead of related codes?

I25.11 should be used when the patient has a confirmed diagnosis of atherosclerotic heart disease with documented episodes of angina pectoris. It is important to differentiate it from codes that do not specify angina or those that refer to other types of heart disease.

What documentation supports I25.11?

Documentation should include a detailed patient history of angina symptoms, results from diagnostic tests confirming atherosclerosis, and any treatment plans or interventions that have been implemented.