Health data standards and systems

Could the committee please advise on principal diagnosis selection for same day coronary angiogram cases when a patient is investigated for a symptom, and there is a finding of coronary artery disease, with no intervention.

For example, a patient is admitted as a day case for a coronary angiogram for investigation of chest pain. The finding on the angiogram cath lab report was mild coronary artery disease (CAD) for medical management only. Should the principal diagnosis be the chest pain (symptom) or the CAD (finding) eg:
1) R07.4 Chest pain, unspecified with I25.11 Atherosclerotic heart disease, of native coronary artery as an additional code, or
2) I25.11 Atherosclerotic heart disease, of native coronary artery alone

ACS 0001 Principal diagnosis states that codes for symptoms, signs and ill-defined conditions are not to be used as principal diagnosis when a related definitive diagnosis has been established.

In the absence of a discharge summary, and the only documentation is of symptoms and findings on a diagnostic report, are we able to make the link that the chest pain is due to the CAD, ie that the CAD is a related definitive diagnosis?

There is a query that answers our question, however it is retired. The query is Same day coronary angiograms principal diagnosis selection (VICC Query #2192) published 2005-06 Second Quarter.

Can the principles from the above retired query still be applied?

In the scenario cited there is no discharge summary and no documented link between the symptom of chest pain and the finding of coronary artery disease. VICC therefore advises that in the scenario cited, assign R07.4 Chest pain as the principal diagnosis, with I25.11 Atherosclerotic heart disease, of native coronary artery as an additional diagnosis if it meets ACS 0002 Additional diagnoses.