Cardiology Coding Alert

Use this fifth digit when a patient with an MI is moved to a different location If you always tack on an unspecified diagnosis code for a myocardial infarction (MI) when you don't have enough information, then you may not be doing your job to the best of your ability. Part of being a good coder is investigating cases when a cardiologist doesn't fully document when the MI happened and what portion of the heart wall the MI damaged.

Follow these four steps, and you'll be choosing the most specific diagnosis code every time. Step 1: Highlight 410 Series for Acute MI A patient has an MI (commonly known as a heart attack). Your cardiologist sees the patient in the hospital, the office or another setting during the eight weeks immediately following the MI. You should code the diagnosis using the 410 series (Acute myocardial infarction), with required fourth and fifth digits, says Donna Baird, RHIT, ACS-CA, coding compliance coordinator at the Heart Center in Topeka, Kan. 

"When coding an MI, it's always nice to have information on the exact location and episode of care, but we don't always get it," says Joanna Anderson, CPC, billing manager and coder at Peninsula Cardiology Associates in Salisbury, Md.

Don't fall for "unspecified": You may look to 410.90 (Acute myocardial infarction; unspecified site and episode of care) if you lack necessary documentation, but don't fall into that trap. 

A cardiologist should be able to determine -- through a combination of diagnostic testing -- an MI's specific location, experts point out. You should talk with your physician regarding the importance of both the MI's location and episode.

What you need to know: You need to figure out where the MI occurred to pick the correct fourth digit, ranging from 0 (Of anterolateral wall) to 9 (Unspecified site). You also have to decide on a fifth digit. Your options are 0 (Episode of care unspecified), 1 (Initial episode of care) or 2 (Subsequent episode of care). Step 2: Find Out Where for 'MI' If the cardiologist documents only "MI," you should plan on doing some investigating. 

Strategy: One tactic is to check for an emergency department (ED) note. You may be able to look at the EKG findings (such as elevation in the inferior and lateral leads) and question either the attending ED physician or a cardiologist to see if the ED note findings are consistent with, for example, an inferolateral MI.

You may also want to check for a cardiac catheterization, coronary angioplasty, echocardiography or even a nuclear perfusion scan report in the chart, but make sure you confirm the MI location with your cardiologist or the attending physician.

If the patient presents with symptoms and positive test results and your cardiologist only [...]