Subsequent Acute Myocardial Infarction Definition – Video

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.

Subsequent Acute Myocardial Infarction Definition – Video

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.

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.

Those guidelines, the only thing that really changed in that is the 4 weeks and the fact that you’re going to continue to code for the initial MI. Now, why is this important? Why would you need 2 code? Well, the initial MI in ICD-10 tells the location of the MI. Is it an anterior wall, is it the inferior wall? Why do they need to know that? Well, if they’re going to do a CABG… where the a aorta comes down in arches – and I got a picture at the bottom of this – then they will often take a graft vein from the leg, plug it into the aorta and down to where they need to bypass. That’s an example of it right there. If it’s that particular part, then, that’s how they bypass.

However, if they bypass – I didn’t put another picture there – if this blockage is over there, would be on the other side of the heart, they don’t do that. They take a mammary vein that’s right there and goes across the chest and they plug it in. They don’t graft from someplace else and pull a vein, they actually take an existing one that’s right there in the area and connect it. And so, that’s two different ways to do it. Again, if you’re going to take a graft from the leg, that’s additional procedure, so on and so forth.

Now why also do they want to know these? We are coding for statistical purposes, we forget that, and it just happens to be a convenient way to get paid. Statistically, they can tell if a person has had a bypass surgery of the anterior wall and this procedure worked; then, they would be able to tell the recovery way and what happened after for that patient, versus taking the other one that a mammary… Now they know. Will this mammary vessel work so much better in this area versus the bypass from the aorta, and so on and so forth? They know that because of statistics.

Now, with ICD-10, they can actually get more information because of where the infarction is located, so it’s huge, the information you can obtain from these codes. Location is very important then.

Now, why would it be important to know what type of initial MI happened within four weeks of the second one? It’s all about the statistics, guys. We can improve the treatment by knowing all of this information, so you do need two codes. Also, just keep in mind in ICD-10 the MS-DRG remains the same for an initial MI or a subsequent one, and you confirm an initial MI date in the documentation. Sometimes it’s not there, so this is something that as coders and as experts, we want to help our providers and clinicians to understand this is documentation, a date that’s incredibly important to the continuing of care for our patient in the coding and the billing. This also changes the way the money comes in because an old MI after four weeks doesn’t carry an HCC for risk adjustment anymore, so they won’t get paid for that treatment; and so, it’s very important.

I just copied there the codes that we were talking about and you can find them in your coding manual, and then the picture of that one particular bypass and how they do that. Again, very exciting? Yes. The guidelines have changed around this, and yes, you do need two codes and that’s why going forward, you will need two codes in that situation. It’s very exciting stuff.

Laureen:  You do get so excited.

Alicia:  I don’t think I can talk as fast as JoAnne, though.

Learn More Details About Acute Myocardial Infarction Definition

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AAPC – Acute MI