Health Information Management

Tip: Take care when crafting queries for angina

CDI Strategies, June 24, 2010

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Despite some misconceptions to the contrary, a coder may report angina, unstable (411.1) if a physician documents any of the following diagnoses and 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 “preinfarction” angina, says William Haik, MD, FCCP, director of DRG Review, Inc., in Fort Walton Beach, FL. Physicians may balk at these queries and state that the patient does not qualify for these more severe types of angina. Haik 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. 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.
Editor’s note: This information first appeared in the CDI Journal article Tips for problematic complications and comorbidities, A–Z.

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