Home Health ICD-9/ICD-10 Alert

Question: Which fifth digit should we use when reporting a myocardial infarction (MI)? Is it ever appropriate to report 410.x1 (Acute myocardial infarction; initial episode of care) in the home health setting? When would you report 0 (episode of care unspecified) as the fifth digit? 


Utah Subscriber

Answer: Fifth-digit 2 (subsequent episode of care) is always appropriate for home care.

The fifth-digit 1 (initial episode of care) covers all care provided to a newly diagnosed myocardial infarction patient until the patient is discharged from acute medical care. If the patient is being transferred to a non-acute facility such as a skilled nursing facility (SNF), intermediate care facility (ICF), home health, rehabilitation facility, or hospice, assign fifth-digit 2, advises the AHA Coding Clinic for ICD-9-CM, second quarter 2006.

Report fifth-digit 1 in M0190 (Inpatient diagnosis) and M0210 (Diagnosis requiring medical or treatment change) for a patient who is being discharged from the hospital after the MI.

Tip: Once the patient's MI is eight weeks old, you should change the code to 414.8 (Other specified forms of chronic ischemic heart disease) if he is still having symptoms.