ICD-10 Chest Pain Vignette

Chest Pain Vignette Pic

Dr. Dana sees a 62-year-old woman who presented to the emergency department with 3-days of intermittent left sided sharp chest that began while she was cooking a meal for her family. She reported that the pain severity was variable but sometimes severe and causing her to feel short of breath, adding that the pain was always more severe with deep inspiration. She reported that the pain was triggered with exertion, but denied any associated symptoms or using any over the counter medications to relieve the discomfort. Overnight, she had been unable to sleep, which prompted her visit to the emergency room. She reported that she had smoked 2-packs of cigarettes daily for 40-years. She had a heart attack in the past, and had CKD (chronic kidney disease) stage 4. Her father passed away from a heart attack at the age of 54.

On physical exam, Dr. Dana noticed normal vital signs but tenderness over her left chest that the patient reported was the same pain she has been experiencing. Her breath sounds are normal, as are her heart sounds. She is given an aspirin and nitroglycerin, and finds that her pain is relieved. Her EKG shows NSR at 75 beats per minute with abnormal T-waves in the V leads. Her troponin is <0.01 and her CKD appears stable. Her remaining lab results are within normal limits.

Dr. Dana admits the patient for “Chest Pain” and “Abnormal EKG.”

ICD-10 requires a high degree of specificity to correctly code chest pain. In this example, it would be better for the ED physician to diagnose, “Precordial pain” or “Anterior chest wall pain” rather than simply “Chest pain”.

The ED coder would assign the following ICD-10 diagnosis codes:

R07.89

Other chest pain/Anterior chest wall pain NOS

R94.31

Abnormal electrocardiogram EKG

I25.2

Old myocardial infarction

N18.4

Chronic kidney disease, stage 4 (severe)

Z72.0

Tobacco use

Z82.49

Family history of ischemic heart disease

For the Evaluation and Management service, the coder would also assign a CPT code such as 99285.

For additional information on ICD-10 coding for emergency medicine, visit the ACEP Reimbursement page at https://www.acep.org/content.aspx?id=28754.

08/2015

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