Subsequent Acute Myocardial Infarction Definition
https://www.cco.us/club/Alicia: Q: [ICD-10 Subsequent Acute Myocardial Infarction] - This example comes from AAPC Quick Reference. I want to know why we need 2 codes. Is this only ICD-10 rule? A patient suffers an acute MI of the inferior wall 2 weeks after suffering an acute MI of the left anterior descending coronary artery. He is admitted for the new MI, which is I22.1 Subsequent ST elevation (STEMI) myocardial infarction of inferior wall I21.02 ST elevation (STEMI) MI of left anterior descending coronary artery. In this example, the second MI occurs within four weeks of the first, so it is a subsequent MI coded from category I22. The patient is admitted for the new MI, so the subsequent MI is the first-listed code, followed by the initial MI.
A: I had to read this a couple of times, like, “Oh, I get it! I understand what they’re asking.” They have the heart attack. In ICD-10 now, you can actually tell and code where it is located at, which is wonderful. But then they have a subsequent one which is pretty common, if you have a heart attack to follow up and have another heart attack. And the guidelines have changed from 9 to 10. You may have heard me say this several times, pretty much the guidelines between 9 and 10 are the same, and predominantly across the board they are. But there are some significant changes and this one of them.
If you happen to have your manual, you’re going to go to Chapter 9 and that’s Diseases of the Circulatory System, e.1; so we’re talking about subsequent MIs. When we’re coding an acute MI, these are the bullet points. This is what you need to know about an acute MI: You’ve got to identify the site with ICD-10. You need to know if the ST elevation, is it a STEMI or NSTEMI? We did another webinar on what’s the difference between a STEMI and NSTEMI. You can go out to YouTube and find that on our MedicalCodingCert because that’s pretty interesting.
They need to know, if it’s a NSTEMI and it evolves into a STEMI, then you assign the STEMI, that’s a guideline and that’s the same in ICD-9. Then, if a STEMI converts to a NSTEMI due to the fact that they give them a thrombolytic therapy where they thin the blood out, then, you’re going to code still the STEMI and that has not changed.
Now, if the encounter occurs while or it ends, equal or less than 4 weeks – now heads-up, this used to be 8 weeks. ICD-9 it’s 8 weeks and they shortened it to 4 weeks. That is a guideline change significant – and this includes transfer to another acute setting or post- acute setting and the patient requires continued care for the MI codes, what you’re going to do is you’re going to code from the I21 and you’re going to keep that continuing in the report. So, encounter occurs greater than 4 weeks, you are going to use an after care code versus the I21.
They need to know, if it’s a NSTEMI and it evolves into a STEMI, then you assign the STEMI, that’s a guideline and that’s the same in ICD-9. Then, if a STEMI converts to a NSTEMI due to the fact that they give them a thrombolytic therapy where they thin the blood out, then, you’re going to code still the STEMI and that has not changed.
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