HCC Coding for Providers: Get to the Heart of It

There is a plethora of ICD-10 codes for coronary artery disease and its related manifestations or complications. Here are a few commonly missed opportunities and provider questions we’d like to share from our ongoing audits…

How do you code a patient with known CAD who comes in for an annual wellness visit or follow-up and has no current angina?

ANSWER: That depends. If there is a prior history of angina, the patient is on anti-anginal medication, and is being monitored for this problem, then it is appropriate to code this as stable angina. That means even if the angina is quiet at the time of the visit, ICD-10 code I25.118 — Atherosclerotic heart disease of native coronary artery with other forms of angina pectoris — is the most specific and complete code to use.

This is a bundled code (CAD and stable angina). The ICD-10 code I20.8 – Other forms of angina pectoris – may also be used if no established CAD.

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

What if this patient with CAD and prior angina has not reported angina for several years, but remains on an anti-anginal regimen/plan of care?

ANSWER: There is no CMS ICD-10 guidance as to a specific time frame for quiet angina at this time.

What are some commonly used codes we are using that do not map?


  • Atherosclerotic heart disease of native coronary artery without angina pectoris, I25.10
  • Old MI, I25.2
  • Chronic ischemic heart disease, unspecified, I25.9

What about angina pectoris, unspecified (I20.9) — does it map to an HCC?

ANSWER: Yes. The following terms are included under this code:

  • Angina NOS
  • Angina syndrome
  • Cardiac angina
  • Ischemic chest pain


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)