Type 1 MI (Q-wave, STEMI, and NSTEMI) is assigned to codes in category I21 and, if occurring as a subsequent MI, in category I22. Type 2 MI (supply/demand mismatch) is coded as I21.A1 whether initial or subsequent. All other MI types are assigned code I21.
Type 2 MI is defined as myocardial infarction secondary to ischemia due to either
increased oxygen demand or decreased supply. It is not due to plaque rupture, and is
usually caused by a condition other than coronary artery disease (CAD).
The key features to diagnose a type 2 MI are as follows:
● An elevated but changing troponin value
● Clinical features inconsistent with type 1 acute MI
● Clinical conditions known to increase the oxygen demand or decrease the
oxygen supply like tachycardia
● Potentially confounding clinical conditions or comorbidities that are
potentially associated or known to be associated with myocardial injury
● Symptoms of acute myocardial ischemia such as typical chest pain.
● New ischemic ECG changes.
● Development of pathological Q waves.
● Imaging evidence of new loss of viable myocardium, significant reversible
perfusion defect on nuclear imaging, or new regional wall motion abnormality
in a pattern consistent with an ischemic etiology.
● Absence of symptoms and/or signs indicating other nonischemic causes of
troponin elevations like myocarditis.
Treatment of type 2 MI is to treat the underlying condition. To adequately assess the
prognosis and determine appropriate further treatment in patients with type 2 MI,
information about whether the patient has (or is likely to have) significant underlying CAD
is essential.
A TYPE 2 MI WILL NEVER BE THE PRINCIPAL DIAGNOSIS
What Is STEMI and NSTEMI?
An ST elevation myocardial infarction (STEMI) is caused by a sudden and long-term blockage of blood supply, according to the Cleveland Clinic. A large area of the heart muscle is damaged due to the blockage and an elevation of the ST segment on the electrocardiogram (ECG) occurs. Changes also occur in the blood levels of key chemical markers. A STEMI, the most serious type of MI, is also called a Q-wave or transmural myocardial infarction.
A Non-ST elevation myocardial infarction (NSTEMI) is caused by a partial or temporary blockage. The extent of the damage to the heart muscle may be relatively small based on the blood supplied by the affected artery. On an ECG, an elevation of the ST segment may not occur, but the chemical markers in the blood show damage. An NSTEMI is less serious than a STEMI and is also referred to as a non-Q wave or non-transmural MI.
Acute myocardial infarction (AMI)
Type 1 ST elevation myocardial infarction (STEMI) and non-ST elevation myocardial infarction (NSTEMI) The ICD-10-CM codes for type 1 acute myocardial infarction (AMI) identify the site, such as anterolateral wall or true posterior wall. Subcategories I21.0-I21.2 and code I21.3 are used for type 1 ST elevation myocardial infarction (STEMI). Code I21.4, Non-ST elevation (NSTEMI) myocardial infarction, is used for type 1 non-ST elevation myocardial infarction (NSTEMI) and nontransmural MIs.
If a type 1 NSTEMI evolves to STEMI, assign the STEMI code. If a type 1 STEMI converts to NSTEMI due to thrombolytic therapy, it is still coded as STEMI.
For encounters occurring while the myocardial infarction is equal to, or less than, four weeks old, including transfers to another acute setting or a postacute setting, and the myocardial infarction meets the definition for “other diagnoses” (see Section III, Reporting Additional Diagnoses), codes from category I21 may continue to be reported. For encounters after the 4 week time frame and the patient is still receiving care related to the myocardial infarction, the appropriate aftercare code should be assigned, rather than a code from category I21. For old or healed myocardial infarctions not requiring further care, code I25.2, Old myocardial infarction, may be assigned.
This event is CCO's Monthly Q&A Webinar! Topics: - Coding Slow Mohs Surgery - MI STEMI Versus NSTEMI Coding - Medical Record Retention - NICU Coding - CFPC Exam Information - Taking the CPC Exam Again
Type 2 MI is defined as myocardial infarction secondary to ischemia due to either
increased oxygen demand or decreased supply. It is not due to plaque rupture, and is
usually caused by a condition other than coronary artery disease (CAD).
The key features to diagnose a type 2 MI are as follows:
● An elevated but changing troponin value
● Clinical features inconsistent with type 1 acute MI
● Clinical conditions known to increase the oxygen demand or decrease the
oxygen supply like tachycardia
● Potentially confounding clinical conditions or comorbidities that are
potentially associated or known to be associated with myocardial injury
● Symptoms of acute myocardial ischemia such as typical chest pain.
● New ischemic ECG changes.
● Development of pathological Q waves.
● Imaging evidence of new loss of viable myocardium, significant reversible
perfusion defect on nuclear imaging, or new regional wall motion abnormality
in a pattern consistent with an ischemic etiology.
● Absence of symptoms and/or signs indicating other nonischemic causes of
troponin elevations like myocarditis.
Treatment of type 2 MI is to treat the underlying condition. To adequately assess the
prognosis and determine appropriate further treatment in patients with type 2 MI,
information about whether the patient has (or is likely to have) significant underlying CAD
is essential.
A TYPE 2 MI WILL NEVER BE THE PRINCIPAL DIAGNOSIS
What Is STEMI and NSTEMI?
An ST elevation myocardial infarction (STEMI) is caused by a sudden and long-term blockage of blood supply, according to the Cleveland Clinic. A large area of the heart muscle is damaged due to the blockage and an elevation of the ST segment on the electrocardiogram (ECG) occurs. Changes also occur in the blood levels of key chemical markers. A STEMI, the most serious type of MI, is also called a Q-wave or transmural myocardial infarction.
A Non-ST elevation myocardial infarction (NSTEMI) is caused by a partial or temporary blockage. The extent of the damage to the heart muscle may be relatively small based on the blood supplied by the affected artery. On an ECG, an elevation of the ST segment may not occur, but the chemical markers in the blood show damage. An NSTEMI is less serious than a STEMI and is also referred to as a non-Q wave or non-transmural MI.
Mastering Acute Myocardial Infarction Coding Using ICD-10-CM
Acute myocardial infarction coding starts with knowing the site of AMI, arteries, whether AMI is initial or subsequent, and type of AMI. Medical Coding Buff
www.medicalcodingbuff.com
Acute myocardial infarction (AMI)
Type 1 ST elevation myocardial infarction (STEMI) and non-ST elevation myocardial infarction (NSTEMI) The ICD-10-CM codes for type 1 acute myocardial infarction (AMI) identify the site, such as anterolateral wall or true posterior wall. Subcategories I21.0-I21.2 and code I21.3 are used for type 1 ST elevation myocardial infarction (STEMI). Code I21.4, Non-ST elevation (NSTEMI) myocardial infarction, is used for type 1 non-ST elevation myocardial infarction (NSTEMI) and nontransmural MIs.
If a type 1 NSTEMI evolves to STEMI, assign the STEMI code. If a type 1 STEMI converts to NSTEMI due to thrombolytic therapy, it is still coded as STEMI.
For encounters occurring while the myocardial infarction is equal to, or less than, four weeks old, including transfers to another acute setting or a postacute setting, and the myocardial infarction meets the definition for “other diagnoses” (see Section III, Reporting Additional Diagnoses), codes from category I21 may continue to be reported. For encounters after the 4 week time frame and the patient is still receiving care related to the myocardial infarction, the appropriate aftercare code should be assigned, rather than a code from category I21. For old or healed myocardial infarctions not requiring further care, code I25.2, Old myocardial infarction, may be assigned.
This event is CCO's Monthly Q&A Webinar! Topics: - Coding Slow Mohs Surgery - MI STEMI Versus NSTEMI Coding - Medical Record Retention - NICU Coding - CFPC Exam Information - Taking the CPC Exam Again