How to Code Chest Pains Without Getting Them

Chest pain is one of the most common complaints in the urgent care setting. Chest pain can be either benign or life threatening. It does not always indicate a cardiac event, and often is unrelated to an acute heart condition. The characteristics of chest pain depend on the cause, and may be described as ischemic, nonischemic, noncardiac gastroesphageal, pulmonary, or musculoskeletal.

Ischemic cardiac diagnosis includes angina, myocardial infarction, aortic stenosis, hypertrophic cardiomyopathy, and coronary vasospasm. Nonischemic cardiac causes of chest pain include pericarditits, aortic dissection, and mitral valve prolapse.

Non-cardiac causes may include gastroesophageal, pulmonary, musculoskeletal, and dermatolgic events. Gastroeseophageal causes may include reflux esophagitis, esophageal spasm, esophageal perforation, gastritis and peptic ulcer disease and achalsia. Pulmonary causes may include pnuemothorax, pulmonary embolism, pleuritis, neoplasm, and bronchitis. Musculoskeletal causes may include costochondritis, rib fracture and compression fracture. One dermatoligic cause is herpes zoster (shingles).

Anxiety or panic attacks often bring on bouts of chest pain, accompanied by intense fear, rapid heartbeat, rapid breathing (hyperventilation), profuse sweating, and shortness of breath.

To avoid labeling a patient with an inappropriate diagnosis, the official coding guidelines that apply to outpatient coding do not allow coding for an “uncertain” diagnosis. In other words, if the diagnosis is documented as “probable,” “suspected,” “questionable,” or “rule out,” this should not be coded as if they are established.

Instead, “code what you know at the time of the encounter.” The patient’s symptoms and signs are acceptable for reporting purposes when a diagnosis has not been established (confirmed) by the provider.

To index chest pain in ICD-9-CM, start with main-term pain, with sub-term chest, followed by essential modifiers describing the type of chest pain. Essential modifiers must be documented as indicated to code the specific type of chest pain.

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