Cardiology Coding Alert
Fifth Digit Coding for MI
Midland Heart Group, Midland, MI
Answer: Yes, the fifth digit 1 designates the first episode of care for a newly diagnosed myocardial infarction. Regardless of how many times the patient is transferred among acute care facilities, use that same digit. For example, if a patient is in the hospital for two weeks with an acute MI of the anterolateral wall, use 410.01 throughout the eight weeks.
Note: Category 410 (acute myocardial infarction ) includes embolism, occlusion, rupture, or thrombosis of the coronary artery as well as an infarction or rupture of the heart, myocardium, or ventricle. The subcategory, or fourth digit, indicates the site of the infarction; the subclassification, or fifth digit, indicates the episode of care.
As long as there isnt a break in the initial care (ie. the patient remains in the hospital) continue to use the fifth-digit of 1.
When the patient is discharged from the acute care setting and sees the cardiologist in his or her office for follow-up, use the fifth digit of 2, which represents subsequent care rendered in the eight weeks following a heart attack. You also use the fifth digit of 2 if the patient is readmitted after the MI occurred for treatment of the same heart attack.
A simple way to remember this is: If the MI has received initial treatment but is less than eight weeks old, use the fifth digit of 2. (It takes heart tissue about eight weeks to form a firm scar and completely heal.) If, during those eight weeks, the patient has a new heart attack at the same site (ie. anterolateral wall), start again with the fifth digit of 1. If another MI occurs at more than one site, assign a separate code for each site.
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