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An acute myocardial infarction (AMI) more commonly known as a heart attack happens when blood stops flowing properly to a part of the heart depriving it of oxygen resulting in injury to the heart muscle. Some of the many risks factors for an AMI include previous cardiovascular disease, old age, tobacco use, high cholesterol, diabetes, high blood pressure, obesity, lack of physical activity, chronic kidney disease, excessive alcohol consumption, and abuse of such drugs as cocaine and amphetamines. ICD-10 CM have some notable changes in the coding of acute myocardial infarction from ICD-9 CM.
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An acute myocardial infarction (AMI) more commonly known as a heart attack happens when blood stops flowing properly to a part of the heart depriving it of oxygen resulting in injury to the heart muscle. Some of the many risks factors for an AMI include previous cardiovascular disease, old age, tobacco use, high cholesterol, diabetes, high blood pressure, obesity, lack of physical activity, chronic kidney disease, excessive alcohol consumption, and abuse of such drugs as cocaine and amphetamines.
WHAT IS AN ACUTE MYOCARDIAL INFARCTION?
WHAT TO EXPECT
1 What is a Myocardial
Infarction?
2 Major Changes in ICD-10
CM
3 ICD-9 CM & ICD-10 CM
Guidelines
4 Requests for Coding Topics
“Blood stops flowing
properly to a part of the
heart depriving it of
oxygen.”
August 2014
Volume 1 Issue 8
By Cynthia Brown, MBA, RHIT, CCS
www.cyntcodinghealthinformationservices.com
CCHIS, P.O. Box 3019, Decatur, GA 30031 404-992-8984 http://www.cyntcodinghealth informationserv ices.com Cynth ia@cyntcodinghealthinformat ionserv ices.com [phone ]
CODING YESTERDAY’S NOMENCLATURE TODAY®
Coding Acute Myocardial Infarction
In ICD-9 CM & ICD-10 CM
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Page 2 Coding Yesterday’s Nomenclature Today
The two main types of acute myocardial infarction (AMI) are:
Transmural AMI which is usually connected to atherosclerosis of a major coronary artery further subclassified into anterior, posterior, inferior, lateral, or septal. A Transmural AMI extends to the whole thickness of the heart where a complete occlusion of the area’s blood supply has occurred. Elevated ST and Q waves are detected on the ECG and they are sometimes referred to as a ST elevation myocardial infarction (STEMI).
Subendocardial AMI involve a small area of the left ventricle, ventricular septum, or papillary muscles. A Subendocardial AMI is also known as a non-ST elevation myocardial infarction (NSTEMI). ST depression is also noted on the ECG. NOTE: It is important to know the difference between STEMI and NSTEMI. Let’s take a look at the more notable changes in the ICD-10 CM coding
versus ICD-9 CM coding. First, codes are located in Chapter 7 Diseases of the Circulatory System (390-459) and included in the category Ischemic Heart Disease (410-414; while the codes for ICD-10 CM are found in Chapter 9 Diseases of the Circulatory System (I00-I99) and are also included in the category Ischemic Heart Disease (I20-I25).
Secondly, the timeframe whereby an AMI is considered acute in ICD-9 CM
is 8 weeks while in ICD-10 is has been reduced considerably to 4 weeks. NOTE: This will require the physician’s documentation to be more specific about the timeframe of an AMI.
Thirdly, the includes notes in ICD-9 CM state “any condition classifiable
to 414.1-414.9 specified as acute or with a stated duration of 8 weeks or less” is included in the 410 Acute Myocardial Infarction category. This is not the case in ICD-10 CM. In ICD-10 CM they are coded as chronic and are found under category I25 Chronic Ischemic Heart Disease. Also, “rupture of heart, myocardium, or ventricle” is included in category 410 Acute Myocardial Infarction in ICD-9 CM; but is found in category 123 Certain Current Complications Following STEMI and non-STEMI within the 28 day period in ICD-10 CM. NOTE: Codes in category 123 MUST be used in conjunction with code(s) I21 or I22. Sequencing depends on the circumstances of the encounter.
Lastly, the term subsequent has one meaning and use in ICD-9 CM and a
totally different meaning and use in ICD-10 CM. In ICD-9 CM the term “subsequent” has to do with the episode of care and is associated with the 5th digit 2 in subcategories 410.0-410.9. The coder is to assign the 5th digit 2 when additional treatment follows the initial episode of care for an AMI that is less than 8 weeks old. This could be for further evaluation, observation, or treatment of a previously treated AMI. In ICD-10 CM, the term “subsequent” has to do with a second AMI that occurs before the 4 weeks have expired for a previous AMI. In this case, the coder is to assigned code(s) from I22 along with code(s) from I21. The sequencing depends on the nature of the encounter.
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“Myocardial Infarction”
“There are two main
types of AMI.”
MAJOR CHANGES IN ICD-10 CM
Coding Yesterday’s Nomenclature Today
ICD-9 CM and ICD-10 CM GUIDELINES
ICD-9 CM:
Subcategories 410.0-410.6 and 410.8 are used for STEMI. Subcategory 410.7 is used for NSTEMI and nontransmural MIs.
If only STEMI or Transmural MI without the site is documented, then the physician should be queried for further specificity.
If an AMI is documented as nontransmural or Subendocardial and the site is provided, it is still coded as a Subendocardial AMI (410.7).
If a NSTEMI develops into a STEMI, assign the STEMI code. If a STEMI changes to a NSTEMI as a result of thrombolytic therapy, it is still coded as a STEMI.
A myocardial infarction past the 8 weeks acute phase is coded to 412 Old Myocardial Infarction if treatment is no longer needed.
ICD-10 CM:
Subcategories I21.0-I21.2 and code I21.3 are used for STEMI. Code I21.4 is used for NSTEMI and nontransmural MIs.
If a NSTEMI develops into a STEMI, assign the STEMI code. If a STEMI changes to a NSTEMI as a result of thrombolytic therapy, it is still coded as a STEMI.
Category I21 should be used for care within the 4 week timeframe, including transfers to another acute or post acute facility. After the 4 weeks, the appropriate aftercare code should be used instead.
Healed or old MIs should be coded to I25.2 Old Myocardial Infarction.
If only STEMI or Transmural MI is documented without the site then it is appropriate to use I21.3. However, I would recommend querying the physician for a more definitive site.
If an AMI is documented as nontransmural or Subendocardial and the site is provided, it is still coded as a Subendocardial AMI (I21.4).
As stated earlier, when a patient has an AMI within the 4 week timeframe of a previous AMI; then a code from category I22 must be used along with a code from category I21. The sequencing of codes depends on the circumstances of the encounter.
NOTE: HIM professionals are encouraged to begin getting their physicians accustomed to complete documentation of AMIs. This should include type, site, and timeframe of the AMI.
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challenged healthcare
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