Current RMA Instruments
| Reasonable Hypothesis SOP | 1 of 2016 as amended |
| Balance of Probabilities SOP | 2 of 2016 as amended |
Changes from previous Instruments
ICD Coding
- ICD-9-CM Codes: 410,411,412,413,414.0,414.10,414.8,414.9,414.11,414.19,429.2,429.79
- ICD-10-AM Code: In the range I20 to I25
Brief description
This is a condition in which a lack of blood flow to heart muscle, due to narrowing, blockage, spasm or dissection in the coronary arteries, causes impairment of cardiac function. This can present in a range of ways, commonly as angina, or as a myocardial infarct or sudden cardiac death. Impaired cardiac function can also be detected on investigation. Coronary atherosclerosis that has not resulted in angina, an infarct or some other cardiac disability, is not covered by the SOP.
Confirming the diagnosis
Diagnosis requires evidence of impaired blood flow in the coronary ateries, and evidence of either clinical consequences or impairment of heart muscle function from that lack of blood flow.
The relevant medical specialist is a cardiologist.
Additional diagnoses covered by SOP
- Acute coronary syndrome
- Angina
- Myocardial infarction
- Myocardial ischaemia
- Ischaemia due to coronary artery dissection
Conditions not covered by SOP
- Coronary atherosclerosis, coronary atheroma, or “coronary artery disease” not resulting in a cardiac disability. e.g. coronary atherosclerosis found on investigation but no evidence of angina or other ischaemia. This should be determined No Incapacity Found (NIF).
- Coronary ischaemia not due to coronary atherosclerosis, thrombosis, vasospasm or dissection of the coronary arteries, e.g. due to anaemia or cardiomyopathy - code to the underlying condition.
Clinical onset
Clinical onset of IHD will be either the first occurrence of symptoms that are subsequently confirmed to be due to IHD, or the first detection of a cardiac disability due to IHD on investigation. A finding of asymptomatic coronary atherosclerosis (e.g. on CT scan or angiography) does not denote a clinical onset of IHD.
Clinical worsening
Clinical worsening could take a number of forms, such as the new development of unstable angina, or the occurence of an infarct. The course of IHD can be affected by treatment, so inability to obtain appropriate treatment could result in a permanent worsening of the condition.