2025 ICD-10-CM code I25.1
(Active) Effective Date: N/A Revision Date: N/A Deletion Date: N/A Cardiovascular Disease - Ischemic heart diseases Diseases of the circulatory system (I00-I99) Feed
Atherosclerotic heart disease affecting the native coronary arteries.
Modifiers may be applicable depending on the circumstances of the service provided and should be used based on official modifier guidelines.
Medical necessity for treatment is established by the presence of clinically significant atherosclerotic disease of the native coronary arteries, demonstrated by objective diagnostic findings.The severity of the disease, symptoms (e.g., angina, myocardial infarction), and the risk of future cardiac events guide the medical necessity of interventions.These decisions are guided by established clinical guidelines, and appropriate documentation is crucial.
The clinical responsibility for this diagnosis lies with a cardiologist or other qualified healthcare professional trained in cardiovascular disease management.Responsibilities include assessing symptoms, ordering diagnostic tests such as coronary angiography, electrocardiograms (ECGs), echocardiograms, and cardiac enzyme tests, and establishing a treatment plan tailored to the patient's specific condition, which may involve lifestyle modifications, medications, or interventions such as angioplasty or coronary artery bypass grafting.
In simple words: This code means the heart's arteries are clogged with plaque (cholesterol and other substances), reducing blood flow to the heart muscle. This specifically affects the heart's natural arteries, not any bypass grafts or transplanted arteries.
I25.1, Atherosclerotic heart disease of native coronary artery, refers to the narrowing or blockage of the coronary arteries due to the buildup of atherosclerotic plaque.This plaque consists of cholesterol, fat, and other substances, reducing blood flow to the heart muscle.The diagnosis requires confirmation through medical imaging (e.g., coronary angiography) or other established diagnostic methods demonstrating the presence of atherosclerosis in the native coronary arteries. This excludes atherosclerosis in coronary artery bypass grafts or transplanted hearts (I25.7-).
Example 1: A 65-year-old male patient presents with chest pain (angina) during exertion.ECG shows ST-segment depression, and coronary angiography reveals significant stenosis in the left anterior descending artery.Diagnosis: I25.1 Atherosclerotic heart disease of native coronary artery., A 70-year-old female patient experiences a myocardial infarction (heart attack).Coronary angiography shows occlusion of the right coronary artery due to severe atherosclerosis. Diagnosis: I25.1 Atherosclerotic heart disease of native coronary artery, I21.0 Acute myocardial infarction of anterior wall., A 58-year-old male patient undergoes a routine cardiac checkup and coronary computed tomography angiography (CCTA) reveals significant atherosclerosis in multiple coronary arteries with no clinical symptoms at present. Diagnosis: I25.1 Atherosclerotic heart disease of native coronary artery.
Detailed history and physical examination, including risk factors for atherosclerosis (e.g., hypertension, hyperlipidemia, smoking, diabetes, family history).Results of relevant diagnostic testing:ECG, cardiac enzyme tests (troponin, CK-MB), echocardiogram, coronary angiography or CCTA, lipid profile.Treatment plan and response to treatment.
** This code is for atherosclerotic heart disease in native coronary arteries.Atherosclerosis in coronary artery bypass grafts or transplanted hearts is coded differently (I25.7-).
- Payment Status: Active
- Modifier TC rule: Not applicable; I25.1 is a diagnostic code.
- Specialties:Cardiology, Internal Medicine, Cardiovascular Surgery
- Place of Service:Office, Hospital (Inpatient and Outpatient), Ambulatory Surgical Center