# MI



## Lizz B (Aug 22, 2012)

New to ER coding and a little confused. Provider's dx: Acute Coronary Syndrome, MI.  Per physician reading EKG, Acute MI.  Patient was transferred to higher level of care with dx for transfer of Acute MI.   My confusion is that the ED provider only states MI, not acute MI.  He does not give additional info re location or timing. Do I code this as an Acute MI, 410.90? Or should I query provider for additional information?  Thanks for any and all help!


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## dscham (Aug 23, 2012)

Hi I am new to ER coding also, but use to code cardiology.  I assume it was the initial visit for the MI and the location (anterior/apical, etc)  was not mentioned I would code 410.91.  
Hope this helps!


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## Lizz B (Aug 24, 2012)

Thanks for your quick reply!  Still researching, but your help is very much appreciated!


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## Raghupathy.Dharmaraj (Nov 10, 2014)

*Coding of myocardial infarction*

The fifth-digit subclassification for category 410 identifies the episode of care. A fifth digit of 1 indicates the first time the patient was seen and treated for MI and may be used at the first hospital where the patient received treatment and at other acute care hospitals to which the patient is subsequently transferred (without interim discharge). For example, if a patient was admitted to Hospital A for AMI and then transferred to Hospital B for a cardiac bypass, code 410.x1 would be assigned as the principal diagnosis for both acute care hospital stays. If the patient was then readmitted to Hospital A for recovery without being discharged home, code 410.x1 could still be assigned as the principal diagnosis. 

A fifth digit of 2 is assigned when a patient is admitted for subsequent care of an MI after the initial care but within eight weeks of the initial MI. Assign code 414.8 if the MI is described as chronic or lasts for eight weeks or longer. 

If a patient was readmitted with an extension of an MI, it is considered a brand-new MI of the specified site, regardless of whether it occurred in the same location as the original infarct or extended to a new location; it is further death of the tissue. Because the patient was released and cardiac enzymes were normal, there will be a new rise in enzymes, and the new infarct will be treated with the same treatment plan as before. According to AHA Coding Clinic for ICD-9-CM, 1989, third quarter, pages 3-4, ?Any subsequent episode of care for another (repeat) myocardial infarction is also assigned the fifth digit 1.?


Sometimes, the MI extends to the same site while in house for the original MI. In that case, it is not considered an extension, since it was at the same site during the same admission. However, if it extended to a different location during the same admission, then assign an additional code from category 410 with a fifth digit of 1 to show the new site to which it extended 

I hope it helps!

Thanks,
Raghupathy Dharmaraj ,CPC,CPC-H,CEDC


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