Chest Pain Coding under ICD-10
Coders should focus on chest pain coding, among other areas, to prepare for ICD-10-CM. Chest pain is a common complaint and could be a symptom of serious conditions. But it does not always mean it is related to acute heart condition or having a heart attack. The characteristics of chest pain depend on the cause, and may be classified as Ischemic, non-ischemic, non-cardiac gastroesphageal, pulmonary, or musculoskeletal.
Examples of Ischemic cardiac diagnoses includes angina, myocardial infarction, aortic stenosis , hypertrophic cardiomyopathy, and coronary vasospasm. Examples of non-ischemic cardiac causes of chest pain include pericarditits, aortic dissection and mitral valve prolapse.
Example of non-cardiac causes include gastroesophageal, pulmonary, musculoskeletal, and dermatologic events. Reflux esophagitis, esophageal spasm, esophageal perforation, gastritis and peptic ulcer disease, and achalasia are examples of gastroesophageal causes. Pneumothorax, pulmonary embolism, pleuritis, neoplasm and bronchitis are pulmonary causes. Costochondritis, rib fracture, compression fracture are examples of musculoskeletal causes. One dermatologic cause is herpes zoster (shingles). Anxiety or panic attacks often bring on chest pain, accompanied by intense fear, rapid heartbeat, rapid breathing (hyperventilation), profuse sweating, and shortness of breath.
What Documentation is required in ICD-10? An example to explain non-cardiac chest pain is as follows:
A patient who arrives to the Emergency Department complaining of chest pain ,starts having chest pain only after being hit by a ball or after a fall or other injury or trauma. This would be a classic example of non-cardiac, musculoskeletal or atypical chest pain and the final diagnosis documented may still be chest pain.
Coders should focus on chest pain, among other areas, in preparing for ICD-10-CM.
The following are ICD-10-CM codes for chest pain coding:
- R07.1 – Chest pain on breathing, Painful respiration(breathing), Pleuritic pain
- R07.2 – Precordial pain, sternal pain
? R07.8 – Other chest pain
? R07.81 – Pleurodynia or Pleurodynia not otherwise specified (NOS),Rib pain
Excludes1: Epidemic Pleurodynia (B33.0) - R07.82 – Intercostal pain, chest pain, non-cardiac, non-cardiac chest pain
? R07.89 – Other chest pain or Anterior chest-wall pain not otherwise specified (NOS) - R07.9 – Chest pain, unspecified,chest pain on exertion, chest pain localized.
There are two Interesting findings from the above set of codes :
- A symptom condition which is not found in ICD-9?inter-costal pain?is found in the ICD-10 code set book.
- There is a specific code for midsternal pain in ICD-9 but is not there in ICD-10.In such case, the coder will have to assign the most accurate code for the condition depending on the documentation.
Last note:
Important note to be documented by physician is when patients are frequently admitted to the hospital with ?rule-out myocardial infarction (MI),? the physician may not document whether the Myocardial Infarction(MI) is actually ruled out that makes it tough for the coder. If the physician ultimately diagnoses a patient who presents with chest pain as having had an MI, the physician must document the Myocardial Infarction(MI) and if not documented, must be queried for clarification. To accurately assign an ICD-10-CM code for a Myocardial Infarction, coders will need to know both the wall and the artery involved in the Myocardial Infarction.
Another point to be noted by coders is, it should not be assumed whether the chest pain is non-cardiac or cardiac even if other diagnoses are present. In such cases, it is always wise to query the physician for clarification for appropriate chest pain coding.