I25.112
BillableAtherosclerotic heart disease of native coronary artery with refractory angina pectoris
HCC Category Mapping
V24HCC 88 — Angina Pectoris
0.000ESRDHCC 88 — Angina Pectoris
0.000RxHCCHCC 188 — Coronary Artery Disease and Angina
0.000What This Code Means
Narrowing of heart arteries causing severe chest pain that does not respond adequately to standard angina medications.
Coding Tips
- •Document that the patient has failed multiple antianginal therapies before assigning this code
- •Refractory angina requires evidence of inadequate symptom control despite optimal medical management
Clinical Significance
Atherosclerotic heart disease with refractory angina represents the most treatment-resistant form of angina, where patients continue to experience ischemic chest pain despite maximal medical therapy. These patients have failed multiple antianginal medications and may not be candidates for revascularization. The refractory nature indicates severe disease burden and high resource utilization, often requiring novel therapies such as enhanced external counterpulsation or spinal cord stimulation.
Documentation Requirements
- ✓Documentation of coronary artery disease involving native vessels
- ✓Explicit documentation of 'refractory angina' or 'intractable angina'
- ✓Evidence of failure of multiple antianginal medications (nitrates, beta-blockers, calcium channel blockers, ranolazine)
- ✓Documentation that revascularization is not feasible or has been attempted
- ✓Impact on functional status and quality of life
- ✓Alternative treatment strategies being employed
Commonly Confused Codes
I25.110 — Same condition with unstable angina: unstable but potentially treatment-responsiveI25.111 — Same condition with documented spasm: specific spasm mechanismI25.118 — Same condition with other forms of angina: for other angina typesI25.119 — Same condition with unspecified angina: less specific
Code Hierarchy
└I25Chronic ischemic heart disease└I25.1Atherosclerotic heart disease of native coronary artery└I25.11Atherosclerotic heart disease of native coronary artery with angina pectoris└I25.112Atherosclerotic heart disease of native coronary artery with refractory angina pectoris
└I25.112Atherosclerotic heart disease of native coronary artery with refractory angina pectoris