HCC Coding Tip: Coronary Artery Disease

Submitted by Barbara Fenton, MD, Medical Director of Augusta Care Partners

Since February is heart month, we thought we’d bring you a reminder about coding for stable angina in patients with coronary artery disease (CAD). Many patients who have CAD and a prior history of angina remain on anti-anginal medication and are actively being monitored for this problem. These are truly more complex patients than we are coding and being credited for managing.

For AMG Providers: Since June of 2018, our outpatient coding specialist has been “teeing up” potential diagnoses in the risk fly-out of Athena, for your review – which you may accept or dismiss. The purpose is to point out opportunities to improve your coding and more accurately reflect your patient panel complexity. Of the HCCs identified thus far this year, 50% were CAD related, with an HCC 88 suggested based on her review of the record. Of course it is up to the provider to determine if this is actively being managed, and appropriate to accept.

What CAD codes that do not reflect complexity is she finding? Most commonly, I25.10 – Atherosclerotic heart disease of native coronary artery without angina pectoris, I25.2 – Old MI, or I25.9 – Chronic ischemic heart disease, unspecified.

What is the code which accurately reflects CAD with stable angina, actively being managed/monitored?

It is not intuitive, but the ICD-10 Coding Manual in fact bundles CAD and stable angina under another code – the one that maps to HCC 88.

  • I25.118 — Atherosclerotic heart disease of native coronary artery with other forms of angina pectoris — is a bundled code for CAD and stable angina, and is the most specific and complete code to use.
  • I20.8 – Other forms of angina pectoris – may also be used if there is no established CAD.

Remember it is not enough to correctly code a diagnosis. Your care plan must support the diagnosis. Each year, both the code and care plan must be re-established.


ICD-10-CM Official Guidelines for Coding and Reporting FY 2018 https://www.cms.gov/Medicare/Coding/ICD10/Downloads/2018-ICD-10-CM-Coding-Guidelines.pdf

ICD-10-CM Official Guidelines for Coding and Reporting FY 2019


International Classification of Disease, Tenth Revision, Clinical Modification (ICD-10-CM)