ICDxICD-10 Medical Coding

ICDxICD-10 Medical Coding

ICD-10 Guide

I25.111

Billable

Atherosclerotic heart disease of native coronary artery with angina pectoris with documented spasm

BILLABLE STATUSYes

IMPLEMENTATION DATEOctober 1, 2015

LAST UPDATED09/06/2025

Code Description

ICD-10 I25.111 is a billable code used to indicate a diagnosis of atherosclerotic heart disease of native coronary artery with angina pectoris with documented spasm.

Key Diagnostic Point:

I25.111 refers to atherosclerotic heart disease of the native coronary artery with angina pectoris accompanied by documented spasm. This condition is characterized by the narrowing of coronary arteries due to atherosclerosis, which leads to reduced blood flow to the heart muscle. Patients typically present with episodes of angina pectoris, which is chest pain or discomfort that occurs when the heart muscle does not receive enough oxygen-rich blood. The documented spasm indicates that there are instances where the coronary artery temporarily constricts, exacerbating the angina symptoms. The anatomy involved includes the coronary arteries, which supply blood to the heart, and their health is critical for maintaining cardiac function. Disease progression can lead to more severe conditions such as myocardial infarction (heart attack) if not managed properly. Diagnostic considerations include a thorough patient history, physical examination, and tests such as electrocardiograms (ECGs), stress tests, and coronary angiography to confirm the presence of atherosclerosis and spasm. Effective management often involves lifestyle changes, medications, and possibly interventional procedures.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

Diagnostic complexity: Requires comprehensive evaluation of symptoms and diagnostic tests.
Treatment complexity: May involve multiple treatment modalities including medication and lifestyle changes.
Documentation requirements: Detailed documentation of symptoms, diagnostic tests, and treatment plans is essential.
Coding specificity: Requires precise coding to differentiate from other forms of heart disease.

Audit Risk Factors

Common coding errors: Misclassification of angina types or failure to document spasm.
Documentation gaps: Incomplete patient history or lack of diagnostic test results.
Billing challenges: Difficulty in justifying the need for specific treatments or interventions.

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

The clinical significance of I25.111 lies in its association with increased morbidity and potential mortality due to heart disease. Understanding this condition is crucial for population health, as it affects a significant portion of the aging population. Quality measures often focus on managing angina symptoms and preventing progression to more severe cardiovascular events. Healthcare utilization patterns indicate that patients with I25.111 may require frequent monitoring and intervention, highlighting the importance of effective management strategies in reducing healthcare costs and improving patient outcomes.

ICD-9 vs ICD-10

The clinical significance of I25.111 lies in its association with increased morbidity and potential mortality due to heart disease. Understanding this condition is crucial for population health, as it affects a significant portion of the aging population. Quality measures often focus on managing angina symptoms and preventing progression to more severe cardiovascular events. Healthcare utilization patterns indicate that patients with I25.111 may require frequent monitoring and intervention, highlighting the importance of effective management strategies in reducing healthcare costs and improving patient outcomes.

Reimbursement & Billing Impact

Reimbursement considerations include the need for clear evidence of atherosclerosis and documented spasm. Common denials may arise from insufficient documentation or failure to demonstrate medical necessity for treatments. Coding best practices recommend using precise codes that reflect the patient's condition and ensuring all documentation aligns with the billed services to minimize audit risks.

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 I25.111?

I25.111 covers atherosclerotic heart disease of the native coronary artery specifically associated with angina pectoris and documented coronary artery spasm. It is essential for the diagnosis to include evidence of both atherosclerosis and episodes of angina linked to spasm.

When should I25.111 be used instead of related codes?

I25.111 should be used when there is clear documentation of atherosclerotic heart disease with angina pectoris and evidence of coronary artery spasm. If the angina is not associated with spasm or if the atherosclerosis is not documented, other codes such as I25.10 may be more appropriate.

What documentation supports I25.111?

Documentation supporting I25.111 should include a detailed patient history of angina episodes, results from diagnostic tests confirming atherosclerosis and spasm, and treatment plans that address both conditions.