I20.2 ICD-10-CM Code: Refractory angina pectoris

Code

I20.2

Description

Refractory angina pectoris

HCC (V28)

No CMS-HCC V28 mapping

RAF reference coefficient

—

Billable

Yes

Payment year

2026

HCC Category Mapping

These are source-labeled model coefficients, not member totals. A category may still be removed by hierarchy or model cleanup rules. Weights are not directly comparable across models: CMS-HCC V28 and V24 use Community, Non-Dual, Aged; ESRD uses the dialysis continuing-enrollee model; RxHCC is the Part D continuing-enrollee, non-low-income, aged weight (a larger scale than CMS-HCC). ACA/HHS has no single weight — it varies by metal level. Actual per-patient RAF contribution depends on member context, hierarchy and cleanup rules, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains available for historical review.

Work I20.2 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →

MEAT review for I20.2

What This Code Means

HCC Buddy maintains structured V28 and V24 mapping, source-labeled coefficient references, and MEAT documentation criteria for I20.2 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

• •Document the medications tried and their doses to establish that standard angina therapy has failed
• •This diagnosis may indicate need for advanced interventions such as cardiac catheterization or newer therapies

Clinical Significance

Refractory angina pectoris is a chronic condition where anginal symptoms persist despite optimal medical therapy and when revascularization is not feasible or has failed. This represents a challenging clinical scenario requiring multimodal pain management, advanced cardiac therapies, and significant healthcare resources. It indicates end-stage ischemic heart disease in many patients.

Documentation Requirements

• ✓Provider documentation explicitly stating refractory or intractable angina
• ✓Evidence of optimal medical therapy (maximum tolerated doses of anti-anginal medications)
• ✓Documentation that revascularization is not an option or has been attempted and failed
• ✓Coronary angiography results showing the basis for non-revascularization
• ✓Functional assessment and impact on quality of life
• ✓Treatment plan including advanced therapies (enhanced external counterpulsation, spinal cord stimulation, etc.)
• ✓Assessment of myocardial viability if applicable

Commonly Confused Codes

• •I20.0: Unstable angina (acute presentation; refractory angina is a chronic condition)
• •I20.1: Angina with documented spasm (vasospasm mechanism; refractory angina may have any underlying mechanism)
• •I20.81: Angina with coronary microvascular dysfunction (specific etiology; different from refractory designation)
• •I25.110-I25.119: Atherosclerotic heart disease with angina (may be the underlying cause but does not capture the refractory nature)
• •I20.9: Angina pectoris, unspecified (much less specific; use I20.2 when documented as refractory)

Child Codes