Angina (411 and 413) ICD-9-CM
•
Angina (411, 413)
o
Chest pain due to ischemia of the heart
o
Subcategory 411.1, Unstable angina
o
Category 413, Angina pectoris
•
Sequencing rules
o
Known cause of angina is sequenced first
o
Angina may not be coded when considered an
inherent part of the condition

32
Chronic Ischemic Heart Disease (414) ICD-9-CM
•
Coronary arteriosclerosis or arteriosclerotic
heart disease (414.0)
o
Fifth digit used to identify whether the
arteriosclerosis is present in a native artery or in a
bypass graft
•
414.00, Coronary artery disease with no information in
the record as to location of disease
•
414.01, Coronary artery disease in a patient with no
history of coronary artery bypass surgery

33
Chronic Ischemic Heart Disease (414) (continued) ICD-9-CM
•
Coronary arteriosclerosis (414.0)
•
414.02, Coronary artery disease in an autologous vein
bypass graft
•
414.03, Coronary artery disease in a nonautologous
vein bypass graft
•
414.04, Coronary artery disease in an internal
mammary artery used for a bypass graft
•
414.05, Coronary artery disease in a bypassed vessel
but not known if graft was arterial or venous

34
Chronic Ischemic Heart Disease (414) (continued) ICD-9-CM
•
Chronic total occlusion of coronary artery
(414.2)
•
Used as an additional diagnosis code
•
Used to code the patient with coronary atherosclerosis
who has a complete blockage of a coronary artery
•
Increased risk of myocardial infarction or death
•
Treated with angioplasty and/or coronary stent
placement but procedure is more difficult in patients
with chronic total occlusion of the coronary artery

35
Chronic Ischemic Heart Disease (414) (continued) ICD-9-CM
•
Coronary atherosclerosis due to lipid rich
plaque (414.3)
•
Used to code the patient with coronary atherosclerosis
due to a specific form of plaque within the vessel
•
Important information for the cardiologist to determine
the most appropriate type of stent to place within the
vessel
•
Code used in addition to a code for the location and type
of coronary atherosclerosis that exists in the patient
(414.00–414.07)

36
Heart Failure—ICD-9-CM
•
Heart failure is the heart’s inability to contract
with enough force to properly pump blood
•
Cause may be coronary artery disease, past
myocardial infarction, cardiomyopathy,
hypertension, or heart valve disease
•
Three effects:
o
Pressure in the lungs is increased
o
Kidney function is hampered
o
Blood is not properly circulated throughout the body

37
Heart Failure (continued)—ICD-9-CM
•
Signs and symptoms are not coded in addition to
heart failure
o
Sudden weight gain, Shortness of breast
o
Walking up breathless at night, trouble sleeping
o
Cough especially when lying down
o
Increased fatigue and weakness
o
Dizziness and fainting
o
Swollen feet, ankles, legs
o
Nausea with abdominal swelling, pain, tenderness

38
Heart Failure (continued)—ICD-9-CM
•
Left-sided Heart Failure
o
Left side of heart must work harder to pump blood
o
Systolic heart failure occurs when left ventricle loses
its ability to contract normally.
Heart cannot pump
blood with sufficient force to push blood into
circulation
o
Diastolic heart failure is when left ventricle loses its
ability to relax and heart cannot fill with blood during
resting period between each beat


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- Fall '19
- Cardiology