Cardiology Coding Alert

Question: I'm confused about the fifth digits I should apply to myocardial infarction (MI) diagnosis codes. What does immediate versus subsequent episode of care mean? What if I don't have enough information to choose? What should I report?

Colorado Subscriber

Answer: Using a fifth digit with myocardial infarction code 410.x (Acute myocardial infarction) can be confusing, but you'll find valuable advice below.

"1" is immediate: Choose 1 (Initial episode of care) for the period of care immediately following an MI until the physician discharges the patient, no matter where the cardiologist provides the care.

Example: If the patient with an MI is admitted to a hospital, then moved to another location for treatment, you should still use 1 as the fifth digit, regardless of the amount of time spent at each facility. You would treat this as a newly diagnosed MI and code accordingly -- basically because the patient was not discharged to go home, meaning this is the same episode of care.

When care is subsequent, choose "2": Use 2 (Subsequent episode of care) 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 eight weeks old.

Example: A patient presents to the cardiologist's office six weeks after discharge of a previous MI. The cardiologist performs an electrocardiogram (ECG), which shows only the previously diagnosed anterior wall infarction. You should use 410.12 (Acute myocardial infarction; of other anterior wall; subsequent episode of care).

Rule: Once the infarction is more than eight weeks old, you should use 414.8. This diagnosis code's descriptor specifically states "any condition classifiable to 410 specified as chronic or presenting with symptoms after eight weeks from date of infarction."

Not enough info? Then fall back on "0." Use 0 (Episode of care unspecified) when you do not have enough information to assign 1 or 2. You should use this digit rarely, because it's important to code as specifically as possible, and you should be able to locate information on when the MI occurred in most cases.