# Acute MI



## jodi (Aug 16, 2007)

Patient comes  in to ER with chest pain, is admitted with Acute MI.
Doc does not specify if it is an initial or subsequent, how should this be coded? Should this be coded as unspecified or should we assume it is initial?
Thank you before hand for your reply.


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## kevbshields (Aug 17, 2007)

Faye Brown states pretty clearly that a fifth digit of 1 is assigned for any newly diagnosed myocardial infarction.  That fifth digit will likely stay the same until the patient is discharged home (through hospital transfers, etc, etc).

I wouldn't use the word "assume" as much as "conclude."  Our goal is to form a basis for our diagnostic code assignment, rather than guess and move on.

Hope this helps.


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## AmberD (Aug 17, 2007)

How do we know that it is newly diagnosised? Like she said it is an ER case. We don't have pervious med rec. and when they come into the ER setting they aren't necessarily in the best condition.
When I read what the guideline says it says that the document has to support what is being dx. So a 5th digit 0 is used when not speficied as initial or subsequent.
So as a coder how can we conclude in an ER setting that it is initial?
Thank you


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## coder911 (Aug 17, 2007)

Hello all,

In my opinion, I would code the 5th as a 1. Here's why: With the info given about the case we know this - the pt is presenting with an acute MI. The definition of acute is "sudden, severe onset - usually of a short duration". I even found one definition that stated "the initial stage of an injury". Though I agree with both sides of this discussion (no specific statement indicating initial or subsequent), I lean to using the initial tx code due to supporting verbiage. Even though you could safely code 410.90, I would use 410.91.
Thank you


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## kevbshields (Aug 17, 2007)

Jason did a terrific job of justifying the use of a fifth digit of 1; likewise, that was my intent in with the Faye Brown comment.


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## jodi (Aug 19, 2007)

Thank you for your help - you made it a little clearer for me. I appreciate your responses!


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