Home Health ICD-9/ICD-10 Alert

The fourth digit is your challence.

Accurately coding a myocardial infarction is like planning to go to a party - you need to know where and when.

The code series 410.xx designates an acute MI (commonly known as a heart attack), and requires a fourth and fifth digit. To choose the fourth digit, check the patient's record to determine where the damage occurred. There are eight codes for specific sites and two additional codes for MIs that don't fit within these specific codes.
 
But don't settle for 410.9x (Acute myocardial infarction, unspecified site) unless you have to. Remember, coding guidelines require you to code to the highest specificity, instructs home health coding expert Prinny Rose Abraham with Minneapolis-based HIQM. Do some detective work to determine the true location.

Discovering the location of the MI is harder in home care because the prior medical record often is not as complete as in other settings. "We very rarely get detailed information that identifies the area of the infarct," says Margaret Rush, OASIS and coding coordinator for Birmingham, AL-based Alacare Home Health & Hospice. This results in frequent use of the unspecified fourth digit, she adds.

First, try this: Query the physician if there is nothing in the medical record to tell you the location, but thoroughly examine the record before approaching the doc, experts say. Some possible sources of the information you need are copies of reports from a cardiac catherization, a coronary angioplasty, an echocardiography or an EKG. The report also will give you the name of the physician or cardiologist who can confirm the location for you, says Sharon Threadgill, coder for the Department of Veteran Affairs Medical Center in Salem, VA.

Choose Your Fourth Digit

Check your documentation and then use this easy coding aid to help you make the right choice for the fourth digit.

Finish With A Fifth Digit

 The other factor important for coding an MI is when it occurred. Diagnosis code 410.xx applies to heart attacks that are specified as acute or happened within the last eight weeks, coding guidelines instruct. In home care, the fifth digit is usually "2" (subsequent episode of care), Rush says. This fifth digit designates an episode  of care following the initial episode, in which the patient is admitted for further observation, evaluation or treatment - but the MI is still less than eight weeks old, the manual instructs.

A fifth digit of "1" is used for the first episode of care for a newly diagnosed MI. Only use "0" as the fifth digit if you can't determine whether you're providing the initial or subsequent episode of care. This situation occurs very rarely, experts say.

Tip: Once the MI diagnosed in the past is healed and the patient has no current symptoms, you would use 412 (Old myocardial infarction), Threadgill says.