Cardiology Coding Alert

Question: The patient is seen in the hospital for a 410.31, and then is discharged. The patient is scheduled to be seen in the office for a follow-up visit. For this follow-up visit, which is less than 8 weeks from the myocardial infarction, is it appropriate to use the fifth digit of "2" on the MI (410.32), or would you still use 410.31?

Codify Member

Answer: You should use 410.32 (Acute myocardial infarction of inferoposterior wall; subsequent episode of care) for this follow-up visit. ICD-9 notes with the 410.xx fifth digit options state that you should "use fifth-digit 2 to designate an episode of care following the initial episode when the patient is admitted for further observation, evaluation or treatment for a myocardial infarction that has received initial treatment, but is still less than 8 weeks old."

You should report 410.31 (Acute myocardial infarction of inferoposterior wall; initial episode of care) only during the initial episode of care. The fifth digit "1" applies until the patient is discharged, regardless of where the cardiologist provides the care. Notes in the ICD-9 manual clarify that you use "1" for the first episode of care, "regardless of the number of times a patient may be transferred during the initial episode of care."

If documentation doesn't specify the episode of care (initial or subsequent), you should use fifth digit "0" (Episode of care unspecified).

If the patient returns more than eight weeks after the infarction, you should use 414.8 (Other specified forms of chronic ischemic heart disease). Notes with this code specify it is appropriate for "any condition classifiable to 410 specified as chronic, or presenting with symptoms after 8 weeks from date of infarction."