Health Information Management

TIP: Couch your query when clarifying unstable angina

CDI Strategies, September 3, 2009

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Editor’s Note: The following tip was excerpted from the article “Tips for problematic CCs, A-Z” in the upcoming edition of CDI Journal.
Angina, unstable (411.1): Despite some misconceptions to the contrary, a coder may report unstable angina if a physician documents any of the following diagnoses (i.e., a query is not required):
  • Progressive angina
  • Accelerated angina
  • Initial (new onset) angina
Since angina unspecified is not a CC, some CDI specialists query physicians using terms such as ‘unstable’ or ‘pre-infarction’ angina. However, physicians may balk at these queries and state that the patient does not qualify for these more severe types of angina. William E. Haik, MD, director, DRG Review, Inc., Fort Walton Beach, FL, recommends a different line of questioning: “A softer term, such as progressive, accelerated, or new onset (initial) angina, may be more appropriate, and all group under 411.1,” he says.
CDI specialists should suspect (and therefore query for) progressive/accelerated angina in patients with a known history of chronic angina whose chronic angina becomes accelerated (i.e., it occurs from less activity than is typical, Haik says.). In contrast, unstable angina requires aggressive physician intervention, such as treatments of IV nitroglycerine/morphine.
Note that when a physician documents acute coronary syndrome (ACS), he or she may not mean that the patient has angina, even though ACS, according to coding guidelines, groups to 411.1. “ACS is a spectrum of disease relating to ischemic heart disease—it could be a patient with unstable angina, or it could be a patient with an acute myocardial infarction,” notes Haik. If a patient is admitted with acute chest pain, and has elevated biomarkers (such as elevated CPK or troponin levels), query the physician to further specify the ACS as a subendocardial or transmural myocardial infarction.

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