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I25.10ICD-10-CM

Atherosclerotic heart disease of native coronary artery without angina pectoris

BillableAdults onlyAdded-code instructions at three levels above the code

How the code is built

I

Chapter

Diseases of the circulatory system

25

Category

Chronic ischemic heart disease

1

Char 4

Atherosclerotic heart disease of native coronary artery

0

Char 5

Without angina pectoris

Chapter

I00 to I99

Diseases of the circulatory system

Block

I20 to I25

Ischemic heart diseases

Subcategory

I25.1

Atherosclerotic heart disease of native coronary artery

Billable

Yes

Complete at 5 characters

Inclusion terms

Coronary artery disease, coronary atherosclerosis, atherosclerotic cardiovascular disease

All classify at I25.1

Age edit

Adults only

Per the Medicare Code Editor

Code also

The presence of hypertension

A block-level instruction, not on the code line

DefinitionCode structureClinical pictureDocumentationDecision guideTabular listComparisonClaim contextDenialsSources

Key takeaways

  • I25.10 codes coronary artery disease in native vessels when no angina is documented
  • Coronary artery disease, coronary atherosclerosis, and atherosclerotic cardiovascular disease all classify to this subcategory
  • Angina is the only thing the fifth character records, so vessel count and stenosis severity change nothing
  • Three separate instructions above the code line call for additional codes, including one for hypertension
  • It is billable, restricted to adults, and displaced by a combination code the moment angina appears in the assessment
1Definition

What ICD-10 code I25.10 means

I25.10 is the ICD-10-CM code for atherosclerotic heart disease of native coronary artery without angina pectoris. It applies when a provider documents coronary atherosclerosis in the patient's own coronary arteries and the record does not document angina.

The terms that reach this code matter more than the descriptor suggests. Coronary artery disease, coronary atherosclerosis, coronary artery atheroma, coronary artery sclerosis, and atherosclerotic cardiovascular disease all classify to I25.1, and I25.10 is the child assigned when angina is absent. Atherosclerotic heart disease NOS classifies at the code itself. A note says only CAD lands here.

Code

I25.10

Descriptor

Atherosclerotic heart disease of native coronary artery without angina pectoris

Chapter

Diseases of the circulatory system

Block

Ischemic heart diseases

Category

I25, chronic ischemic heart disease

Subcategory

I25.1, atherosclerotic heart disease of native coronary artery

Billable

Yes

Inclusion term at I25.10

Atherosclerotic heart disease NOS

Age edit

Adults, per the Medicare Code Editor

The descriptor has not changed in any fiscal year since 2015. What creates exposure here is the synonym list, which is the most unreliable of any code in this glossary.

Single vessel, double vessel, triple vessel, and multi-vessel coronary artery disease all appear among the approximate synonyms for I25.10. There is no vessel-count character in the code. Neither is there one for stenosis severity. A catheterization report describing triple vessel disease with eighty percent stenosis produces exactly the same code as a single non-obstructive lesion on computed tomography.

The same list also contains cerebrovascular disease, which is not coronary disease at all and classifies elsewhere entirely. Treat these synonym lists as a prompt to read the tabular entry, never as a routing table.

2Code structure

The fifth character asks one question, and three instructions sit above it

I25.10 is complete at five characters, and the fifth character records only whether angina is present.

What the fifth character captures

No angina

I25.10

Unstable angina

I25.110

Angina with documented spasm

I25.111

Refractory angina

I25.112

Other forms of angina

I25.118

Angina, type not stated

I25.119

What it does not capture at all

One, two, three, or multiple vessels

None

Percentage of stenosis

None

Which artery is involved

None

Prior stent or bypass, where native disease is the diagnosis

None, but add the status code

Chronic total occlusion

None, but add the occlusion code

Calcified lesion or lipid-rich plaque

None, but add the plaque code

Three levels of added-code instructions reach this code, and none of them appear on the code line.

Block, I20 to I25

Code also the presence of hypertension

Category, I25

Use additional code for chronic total occlusion, and for tobacco use, dependence, history, or exposure

Subcategory, I25.1

Use additional code, if applicable, for calcified coronary lesion or lipid-rich plaque.

A coder verifying I25.10 by opening the code entry sees one inclusion term and an age edit. Everything that actually needs to accompany the code sits one, two, or three levels up the hierarchy.

3Clinical picture

Clinical findings documented under I25.10

Coronary atherosclerosis without angina is often identified on testing rather than from symptoms, which shapes what the record contains.

Imaging and testing

Coronary angiography showing stenosis, computed tomography angiography showing plaque or calcium, stress testing showing ischemia

Symptoms

Typically absent, or explicitly documented as absent

Risk factors

Hypertension, diabetes, hyperlipidemia, tobacco use, family history

History

Prior myocardial infarction, prior stent placement, prior bypass grafting

Treatment

Antiplatelet therapy, statin therapy, risk factor management

The finding that changes the code is the one the record says is missing. An affirmative statement that the patient has no angina is what supports the fifth character, and a note that simply never mentions chest pain is weaker support than one that rules it out.

4Documentation

What the chart must show

  • A provider-stated diagnosis of coronary atherosclerosis or coronary artery disease, not a suspected or possible one
  • Whether the disease involves native vessels, bypass grafts, or a transplanted heart
  • An explicit statement about angina, including its absence
  • Objective findings supporting the diagnosis, from catheterization, computed tomography, or stress testing
  • Hypertension status, since the block instruction calls for it
  • Tobacco use, former use, or exposure, since the category instruction calls for it
  • Chronic total occlusion, calcified lesion, or lipid-rich plaque where documented
  • Prior stent or bypass, so the status code can be reported
  • Prior myocardial infarction, which is a separate reportable diagnosis

The defect that undermines this code most is internal contradiction. A note asserting no angina while the same encounter records exertional chest pain, nitroglycerin use, or a positive stress test does not support I25.10. Query before assigning, because a reviewer reading the whole note will find the conflict.

5Decision guide

When to assign I25.10, and when not to

CAD, coronary atherosclerosis, or ASCVD, no angina

I25.10

CAD with angina, type not stated

I25.119, not I25.10 with a separate angina code

CAD with unstable angina

I25.110

CAD with refractory angina

I25.112

Angina with no atherosclerosis documented

I20.-, and I20.9 cannot pair with I25.119

Atherosclerosis of a bypass graft or transplanted heart

I25.7-

Native vessel disease in a patient with a prior bypass

I25.10, since the diagnosis is the native disease

Atherosclerosis of other coronary vessels

I25.81-, reportable alongside I25.10

Chronic total occlusion of a coronary artery

I25.10 plus I25.82

Prior myocardial infarction with current CAD

I25.10 plus I25.2

Silent myocardial ischemia

I25.6

Ischemic cardiomyopathy

I25.5

Non-ischemic myocardial injury

I5A, which the category Excludes2 separates

Atheroembolism

I75.-

Possible or suspected CAD

Query, since a suspected condition is not coded as established

The combination code rule decides most of these encounters. When atherosclerosis and angina are both documented, the classification provides a single code that captures both, and the guidelines presume the relationship unless the provider documents otherwise. Reporting I25.10 alongside a separate angina code splits one diagnosis into two and misstates the patient. The Excludes1 at I25.119 confirms the direction, since unspecified angina without atherosclerosis is expressly excluded from the combination code.

Query rather than default when the note says CAD with no angina statement, when chest pain or antianginal therapy appears anywhere in the record, and when a catheterization report is in the chart but the assessment carries no diagnosis forward.

6Tabular list

Instructional notes at I25.10 and above

Inclusion term at I25.10

Atherosclerotic heart disease NOS

Inclusion terms at I25.1

Atherosclerotic cardiovascular disease, coronary artery atheroma, coronary artery atherosclerosis, coronary artery disease, coronary artery sclerosis

Excludes2 at I25.1

Atheroembolism (I75.-), atherosclerosis of coronary artery bypass grafts and transplanted heart (I25.7-)

Use additional at I25.1

Coronary atherosclerosis due to calcified coronary lesion (I25.84), coronary atherosclerosis due to lipid-rich plaque (I25.83)

Excludes2 at I25

Non-ischemic myocardial injury (I5A)

Use additional at I25

Chronic total occlusion of coronary artery (I25.82), and the tobacco status codes

Code also at I20 to I25

The presence of hypertension

Excludes2 at I25.81

Atherosclerotic heart disease of native coronary artery without angina pectoris (I25.10), pointing back at this code.

Two notes here behave in ways coders get wrong in opposite directions.

The hypertension instruction is a code also, and it applies to every ischemic heart disease code. It sits at the block level, so it never appears when verifying I25.10 alone. Hypertension is present in most CAD patients, and its code is dropped constantly.

The I25.81 relationship is an Excludes2, which is a permission. Atherosclerosis of other coronary vessels is a separate condition from native coronary artery disease, and a patient documented with both is correctly reported with a code from each. Nothing here prohibits the pair.

7Comparison

Codes frequently confused with I25.10

I25.110

Descriptor

Atherosclerotic heart disease of native coronary artery with unstable angina pectoris

Use instead when

Unstable angina is documented

I25.111

Descriptor

The same, with angina pectoris with documented spasm

Use instead when

Vasospastic angina is documented

I25.112

Descriptor

The same, with refractory angina pectoris

Use instead when

Refractory angina is documented

I25.118

Descriptor

The same, with other forms of angina pectoris

Use instead when

Another form of angina is documented

I25.119

Descriptor

The same, with unspecified angina pectoris

Use instead when

Angina is documented without a stated type

I20.-

Descriptor

Angina pectoris

Use instead when

Angina is documented without atherosclerosis

I25.2

Descriptor

Old myocardial infarction

Use instead when

A prior infarction is documented, reportable alongside

I25.5

Descriptor

Ischemic cardiomyopathy

Use instead when

Ischemic cardiomyopathy is documented

I25.6

Descriptor

Silent myocardial ischemia

Use instead when

Silent ischemia is documented

I25.7-

Descriptor

Atherosclerosis of coronary artery bypass grafts and transplanted heart

Use instead when

The graft or transplanted heart is the diseased vessel

I25.81-

Descriptor

Atherosclerosis of other coronary vessels without angina pectoris

Use instead when

Other coronary vessels are involved, reportable alongside

I25.82

Descriptor

Chronic total occlusion of coronary artery

Use instead when

Total occlusion is documented, added to I25.10

I25.83, I25.84

Descriptor

Coronary atherosclerosis due to lipid-rich plaque, and due to calcified coronary lesion

Use instead when

Plaque composition is documented; added to I25.10

I25.89

Descriptor

Other forms of chronic ischemic heart disease

Use instead when

Another chronic ischemic form is documented

I25.9

Descriptor

Chronic ischemic heart disease, unspecified

Use instead when

Ischemic heart disease is documented without atherosclerosis stated

I5A

Descriptor

Non-ischemic myocardial injury

Use instead when

The injury is non-ischemic, which the category Excludes2 separates

I75.-

Descriptor

Atheroembolism

Use instead when

Atheroembolism is documented

I70.-

Descriptor

Atherosclerosis of other arteries

Use instead when

The atherosclerosis is peripheral rather than coronary

I21.-

Descriptor

Acute myocardial infarction

Use instead when

An acute infarction is occurring

I10 to I1A

Descriptor

Hypertensive diseases

Use instead when

Hypertension is present, reported alongside under the code; also note

F17.-, Z72.0, Z87.891, Z77.22, Z57.31

Descriptor

Tobacco dependence, use, history, and exposure

Use instead when

Required additionally under the category instruction

8Claim context

Services commonly reported with I25.10

I25.10 supports cardiology and primary care evaluation and management, the diagnostic workup that establishes the disease, and the long-term medical management that follows. Coronary computed tomography angiography, stress testing, nuclear perfusion imaging, echocardiography, and diagnostic catheterization are all reported against it.

Coverage for advanced cardiac imaging is set contractor by contractor rather than nationally, and the policies key on documented symptoms, risk profile, and prior testing. A stable asymptomatic patient carrying I25.10 supports a narrower set of studies than a symptomatic one, which is another reason the angina statement in the note matters beyond code selection.

Cardiac rehabilitation and intensive cardiac rehabilitation carry their own qualifying conditions and session limits, and a diagnosis of stable coronary disease alone does not establish eligibility. Confirm the applicable local coverage determination before submitting imaging or rehabilitation services with this code.

9Denials

Coding errors that cause denials

Reporting I25.10 with a separate angina code

Assign the applicable I25.11- combination code instead

Coding I25.10 when the note contradicts itself on angina

Query, since chest pain or antianginal therapy in the record undercuts the fifth character

Coding I25.10 for graft or transplanted heart disease

Assign the applicable I25.7- code

Omitting the hypertension code

Report it, since the block carries a code-also instruction

Omitting the tobacco status code

Report the applicable code, since the category instruction requires it

Missing the chronic total occlusion, calcified lesion, or lipid-rich plaque code

Add the applicable code when documented

Searching for a vessel-count or stenosis character

Report I25.10 regardless of single, double, or triple vessel documentation

Dropping I25.2 when a prior infarction is documented

Report both, since old myocardial infarction is a separate diagnosis

Coding I25.10 for a patient under the age edit

Review the diagnosis, since the code is restricted to adults

Assigning I25.10 from a possible or suspected CAD statement

Query, since a suspected condition is not coded as established

10Sources

Where to verify I25.10

ICD-10-CM Official Guidelines for Coding and Reporting

Combination code conventions, the presumed relationship between atherosclerosis and angina, and the rule against coding suspected conditions

ICD-10-CM Tabular List at I25.1, I25, and the I20 to I25 block

The inclusion terms, the Excludes2 notes, and the added-code instructions at all three levels

ICD-10-CM Tabular List at I25.119

The Excludes1 note confirming that unspecified angina without atherosclerosis codes elsewhere

CMS ICD-10 code page and the FY 2026 files

Current code files, the annual addenda, and the Medicare Code Editor age edit

Laboratory NCD list

Confirms cardiac biomarker testing is not among the 23 national laboratory policies

Medicare Coverage Database

Search your contractor's determinations for coronary computed tomography angiography, stress testing, and cardiac rehabilitation.

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Last reviewed August 2026

This page is a free reference for billing and coding teams and is not coding, legal, or clinical advice. Code selection depends on the documentation in the record and on the policy of the payer being billed. Verify every code, instructional note, and sequencing rule against the current ICD-10-CM files and the Official Guidelines for Coding and Reporting for the applicable date of service. ICD-10-CM is maintained by the CDC's National Center for Health Statistics and published by CMS. CPT is a registered trademark of the American Medical Association. TruCare is not affiliated with CMS, NCHS, the AHA, or the AMA.

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