Coronary Artery Disease (CAD)

Patients with CAD?*

Coronary artery disease (CAD) is the most common type of heart disease. CAD can lead to angina, heart attacks and failures and arrhythmias. It is the leading cause of death in the United States.1

Arrhythmias

• Atrial Fibrillation I48.91

• Atrial flutter I48.92

• Atrial tachycardia I47.1

• Atrioventricular block, complete I44.2

• Paroxysmal ventricular tachycardia I47.2

• Supraventricular tachycardia I47.1

• Sick Sinus Syndrome I49.5

• Ventricular tachycardia I47.2

• Ventricular fibrillation I49.01, treated in a facility setting

• Ventricular flutter I49.02, treated in a facility setting

Patients at risk of developing the disease may suffer from: hypertension, high cholesterol, smoking, poor diet, obesity, inactivity, and other health conditions such as diabetes.2 Patients should be screened for a cardiovascular disease every 5 years.3

CAD I25.10 with

Angina pectoris I25.119

Treatment: rest and/or nitroglycerin4

Unstable angina I25.110

It should be treated as an emergency since the patient could be having a heart attack.4

Acute myocardium infarction (AMI) I21.9

Subsequent AMI I22.9

Treatment may include: anticoagulants, lipid-lowering medications, pacemaker, and others

• For AMI between 0-28 days (or 4 weeks) use category I21.- Use I25.2 (Old MI) for more than 28 days (4 weeks) AMIs or when the timeframe is unknown.

• Use category I22.- to identify a subsequent AMI during the acute timeframe of the first unspecified or type 1 AMI. Subsequent AMIs do not extend the original AMI’s timeframe; therefore, once the 28 days (4 weeks) are over the MIs should be coded as old I25.2.

• For subsequent type 2 AMIs assign only code I21.A1. For subsequent type 4 or type 5 AMIs, assign only code I21.A9

Monitor periodically these conditions and their plan of treatment. Some patients do not adhere to medications, diet or care plan. We recommend scheduling one face-to-face visit before July 1st, and one before December 31st.

References and Additional Notes:

* This tool is not intended to diagnose, evaluate or treat patients. Each provider is responsible for the clinical and diagnostic decisions pertinent to their patient’s medical care. ** CMS-HCC scores are based on CMS’ 2020 community-nondual-aged enrollees.

1. US National Library of Medicine. Coronary Artery Disease. Excerpted: https://medlineplus.gov/coronaryarterydisease.html

2. American Academy of Family Physicians. CAD. Excerpted: https://familydoctor.org/condition/coronary-artery-disease-cad/?adfree=true

3. Medicare Claims Processing Manual Chap. 18 - Preventive and Screening Services. Excerpted: https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c18.pdf

4. American Heart association. Angina Pectoris (Stable Angina). Excerpted: https://www.heart.org/en/health-topics/heart-attack/angina-chest-pain/angina-pectoris-stable-angina HCCs: