Cardiology Coding Alert

Turn to I25.2 for old or healed MIs.

Reporting myocardial infarctions (MI) in your cardiology practice can be tricky. But, being familiar with the numerous rules in the ICD-10 Official Guidelines for Coding and Reporting can help the process go smoother.

Take this coding quiz to brush up on your MI coding smarts.

Type I NSTEMI Evolved to STEMI? Read This

Question 1: If the patient’s type I NSTEMI evolves to STEMI, should we report I21.4 (Non-ST elevation (NSTEMI) myocardial infarction)?

Answer 1: No. If the patient’s type 1 NSTEMI evolves to STEMI, you should assign the appropriate STEMI code, not the NSTEMI code, according to the guidelines.

Focus on This Rule if Thrombolytic Therapy Converts Type I STEMI to NSTEMI

Question 2: What ICD-10 code should we report if the patient’s type I STEMI converts to NSTEMI because of thrombolytic therapy?

Answer 2: You should report the appropriate STEMI code if the patient’s type 1 STEMI converts to NSTEMI due to thrombolytic therapy.

Observe the 4-Week Rule for MIs

Question 3: What is the four-week rule pertaining to MIs?

Answer 3: You should report the appropriate codes from category I21- (Acute myocardial infarction) for encounters that occur while the patient’s MI is equal to or less than four weeks old. This includes transfers to another acute setting or a post-acute setting. Note: The MI must meet the definition for “other diagnoses.”

However, when reporting encounters after the four-week time frame where the patient is still receiving care related to his MI, you should report the appropriate aftercare code, not a code from category I21-., per the guidelines.

Mark Down I25.2 for Old or Healed MIs

Question 4: Which ICD-10 code should we report for old or healed MIs that don’t require further care?

Answer 4: You should report I25.2 (Old myocardial infarction) for old or healed MIs not requiring further care.

Pinpoint This Code for Type I STEMI With no Site

Question 5: The cardiologist only documents type I STEMI without the site. Which code should we report?

Answer 5: If the cardiologist only documents type 1 STEMI without the site, you should report I21.3 (ST elevation (STEMI) myocardial infarction of unspecified site), via the guidelines.

Rely on Options from Category I22- for Subsequent Type 1 or Unspecified MIs

Question 6: How should we report type 1 or unspecified MIs?

Answer 6: You should report the appropriate code from category I22- (Subsequent ST elevation (STEMI) and non-ST elevation (NSTEMI) myocardial infarction) for a patient who has suffered a type 1 or unspecified MI and experiences a new MI within the 4-week time frame of his initial MI.

Don’t miss: You must report a code from category I22- in conjunction with a code from category I21-. The sequencing of these codes depends upon the circumstances of the encounter.

Turn to These Codes to Subsequent Types 2, 4, and 5 MI

Question 7: I’m new to cardiology and have been studying the rules for reporting subsequent MIs. I think I understand how to report subsequent type 1 and unspecified MIs, but I’m not sure about the other types. Can you help me?

Answer 7: You should report subsequent type 2 MI with code I21.A1. For subsequent type 4 or type 5 MI, you should report code I21.A9.

See how to Handle Different Types of MI

Question 8: We had a patient who suffered from type 1 STEMI, then four weeks later, he had a subsequent type 2 MI. How should we handle this situation?

Answer 8: Since your patient had a subsequent MI of one type, and within four weeks, he suffered from a different type of MI, you should report the appropriate codes from category I21- to identify each type, per the guidelines.

Important: You should not report a code from category I22- in this situation because you should only report codes from this category if both the initial and subsequent MIs are type 1 or unspecified.