I25.721
BillableAtherosclerosis of autologous artery coronary artery bypass graft(s) with angina pectoris with documented spasm
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
Plaque buildup in an autologous artery bypass graft causing chest pain with documented coronary artery spasm.
Coding Tips
- •Confirm documentation explicitly mentions vasospasm or spasm of the graft
- •This code requires both atherosclerosis and documented spasm to be present
Clinical Significance
This code identifies atherosclerosis of an autologous artery coronary bypass graft with vasospastic (Prinzmetal) angina. Arterial grafts, particularly internal mammary artery grafts, can be subject to both fixed atherosclerotic disease and superimposed vasospasm. This dual mechanism has important therapeutic implications, as vasospasm requires calcium channel blocker therapy in addition to standard atherosclerotic disease management.
Documentation Requirements
- ✓History of CABG with autologous arterial graft type documented (internal mammary artery or radial artery)
- ✓Evidence of atherosclerotic disease in the arterial graft
- ✓Documented vasospasm — confirmed by provocative testing, angiography, or characteristic clinical presentation
- ✓Angina pattern consistent with spasm: episodic rest angina, transient ST elevation, cyclic/nocturnal occurrence
- ✓Treatment with calcium channel blockers or nitrates targeting the vasospastic component
Excludes 1 — Do NOT code together
- angina pectoris with documented spasm without atherosclerosis of autologous artery coronary artery bypass graft(s) (I20.1)
Commonly Confused Codes
I25.711 — Autologous vein CABG with documented spasm angina; vein graft rather than arterial graftI25.720 — Autologous artery CABG with unstable angina; hemodynamic instability rather than vasospasmI20.1 — Angina pectoris with documented spasm; does not include graft-specific atherosclerosisI25.728 — Autologous artery CABG with other forms of angina; for angina that is not spasm, unstable, or refractory
Code Hierarchy
└I25Chronic ischemic heart disease└I25.7Atherosclerosis of coronary artery bypass graft(s) and coronary artery of transplanted heart with angina pectoris└I25.72Atherosclerosis of autologous artery coronary artery bypass graft(s) with angina pectoris└I25.721Atherosclerosis of autologous artery coronary artery bypass graft(s) with angina pectoris with documented spasm
└I25.721Atherosclerosis of autologous artery coronary artery bypass graft(s) with angina pectoris with documented spasm