Cardiology Coding Alert
Boost Your MI Expertise With a Quick Quiz
Hint: Do you know the four-week rule? Choosing the appropriate ICD-10-CM code for your claim is always tricky, no matter the condition you’re coding, because this code set offers so many different options — all hinging on specificity. Myocardial infarctions (MIs) are no different. When reporting for this condition, you must know the exact type of MI, as well as its age and location. Answer the following questions to make sure you know how to submit clean MI claims in your practice. First, Define MI for Clarity Question 1: What is a myocardial infarction (MI)? Answer: A myocardial infarction (MI) is a heart attack, explains Rebecca Sanzone, CPC, CPMA, quality assurance specialist at St. Vincent Medical Group/Accension Health and coding consultant at the American College of Cardiology. During an MI, a portion of the patient’s heart is deprived of oxygen due to a blockage of a coronary artery. Rely on These Options for STEMIs Question 2: My cardiologist documented a type I ST elevation myocardial infarction (STEMI). Which ICD-10-CM code should I report for this condition? Answer: You have several codes to choose from for a STEMI. They are as follows: Don’t miss: A STEMI is also known as a transmural acute MI, Sanzone says. The electrocardiogram (ECG) will show ST elevation and Q waves. “The ST segment on an EKG will elevate when a patient experiences an acute MI. A STEMI usually indicates a total blockage in the heart,” says Robin Peterson, CPC, CPMA, manager of professional coding services, Pinnacle Integrated Coding Solutions, LLC in Centennial, Colorado. “Another term used is ‘transmural’ meaning there is ‘full-thickness’ damage to the myocardium. A NSTEMI is generally caused by a partial blockage, and the condition may not present as acutely. The patient may be observed for a period with serial EKGs and lab tests looking at the patient’s troponin levels before it’s ruled as an acute MI.” Different types of STEMI sites include anterior, posterior, inferior, lateral, and septal. Your cardiologist may treat a STEMI with thrombolysis using tissue plasminogen activator (tPA) administered intravenously, percutaneous transluminal coronary angioplasty (PTCA) with or without stent placement, and coronary artery bypass graft (CABG). Turn to 1 Code for NSTEMIs Question 3: Which code should I report if my cardiologist documented a type 1 non-ST elevation myocardial infarction (NSTEMI) or a nontransmural myocardial infarction? Answer: If your cardiologist documents NSTEMI, you should report I21.4 (Non-ST elevation (NSTEMI) myocardial infarction). Don’t miss: If your cardiologist documents that the patient’s type 1 NSTEMI evolves to a STEMI, you should report the appropriate STEMI code, per the ICD-10-CM Official Guidelines for Coding and Reporting. However, if a type 1 STEMI converts to a NSTEMI because of thrombolytic therapy, you should report this condition with a STEMI code. An NSTEMI is also referred to as a subendocardial acute MI, non-transmural MI, or a non-Q wave MI. In fact, you will see these as included conditions for code I21.4. The ECG for an NSTEMI will show ST depression. Pinpoint Age of MI Question 4: Why does the age of the MI matter? Answer: The age of the MI matters because you will report different codes based upon this information. For example, if the MI is equal to or less than four weeks old and it meets ICD-10’s definition of “other diagnoses,” you should report the appropriate code from category I21-. This includes “transfers to another acute setting or a postacute setting,” per the guidelines. However, if the encounter occurs after the four-week timeframe, and the patient is still receiving care related to the MI, you should report the appropriate aftercare code instead of a code from category I21-. If the patient has an old or healed MI that doesn’t require further care, you can report I25.2 (Old myocardial infarction). Patient Has Type 2 MI? Do This Question 5: How should I report type 2 MIs? Answer: You should report type 2 MIs, which are due to demand ischemia or secondary to ischemic imbalance, with code I21.A1 (Myocardial infarction type 2). In this case, you should always code the underlying cause first on your claim. You should never report I24.8 (Other forms of acute ischemic heart disease) for the demand ischemia, per the guidelines. “If a type 2 AMI is described as NSTEMI or STEMI, only assign code I21.A1,” according to the guidelines. Mind Important Documentation Details Question 6: What are some details I should look for in the documentation when reporting MIs? Answer: You must know if the episode you are reporting for is “initial” or “subsequent” and well as the “duration,” Sanzone says. You must also know the location and type of MI. “It is very important that providers know the coding rules, so they give you the information you need to specifically code the location, type, duration, timing, etc.,” she adds.
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