Thursday, February 14, 2013

Code for the Day: It's All About Heart (I21.-& I22.-)

I am not a fan of Valentines Day.  And please don't mistake this for bitterness, I just find it ridiculous that we have a holiday dedicated to telling the ones we love that we love them when there are 364 other perfectly good days in the year to confirm the sentiment.  So I really just see Valentines Day as an excuse for my grocery store to mark up the cost of roses for 2 weeks in February.  And let's be real here: I hate the combination of pink and red hearts.  I don't know what it is, but it makes me queasy.  Pink hearts alone are fine.  Red hearts alone are dandy.  But together, ick.  And it get even worse when they throw in those purple hearts for good measure.

As I sit here with my pink heart necklace - after all, I am a festive person and there are no red hearts in sight - I do like Valentines Day as a reminder of something more important: February is American Heart month.  Maybe you "go red" on Fridays or wear a red ribbon.  Maybe you take the month to become more educated on heart disease and the warning signs of a heart attack.  Today, I think we should definitely focus on ICD-10 coding for myocardial infarction!  So consider this my valentine to you: a short tutorial on what to expect in ICD-10 for coding myocardial infarction.

The first thing you need to know is that the definition of an acute myocardial infarction (AMI) has changed.  It is no longer one that has occurred within the past 8 weeks, the period is now reduced to 4.  You also no longer need to know if the AMI episode is the initial or a subsequent encounter for treatment.  In fact, forget everything you know about coding AMI in ICD-9-CM because it will just confuse you in ICD-10-CM.  Here are the highlights:
  • The new period for an AMI is 4 weeks
  • The terms ST elevation myocardial infarction (STEMI) and non-ST elevation myocardial infarction (NSTEMI) are now part of the code titles, not just inclusion terms for the codes
  • AMI codes to two categories: 
    • I21, ST elevation (STEMI) and non-ST elevation (NSTEMI) myocardial infarction
    • I22, Subsequent ST elevation (STEMI) and non-ST elevation (NSTEMI) myocardial infarction
  • Additional characters report the specific site of the AMI (heart wall or vessel)
  • Sequencing depends on the circumstances of admission
The key to knowing when to use a code from category I21 versus one from category I22 is not when the patient receives treatment, but for which AMI he is receiving treatment for.  

Let's take an example.  Bob comes in February 14 with a heart attack.  This is so tragic for Bob's wife, who did not get her roses.  For this Valentines Day visit, we assign a code from category I21 for an initial AMI.  This is the first heart attack Bob has had in the last 4 weeks.  

Let's say Bob comes back on his anniversary, February 28 with a second heart attack. I'm really starting to feel sorry for Bob's wife.  Oh, and Bob too. For this second visit, we would assign a code from category I22 to show that this is a subsequent heart attack that occurred within the 4 week period of his initial heart attack.  You would assign a code from category I21 as a secondary diagnosis to report that first heart attack on Valentines Day.

As for sequencing, notice in Bob's case, I22 was put first on the second visit since it was the reason for his admission (after study, yada yada).  But what if Bob had been admitted for that first heart attack on the 14th and experienced his second while he was an inpatient?  In this case, the I21 would be sequenced first with I22 as a secondary.  Again, sequencing depends on the circumstances of admission.

I'll just let that sink in a bit.

Have a healthy and happy Valentines Day and enjoy the ones you love.  And if you must indulge, might I recommend some antioxidant chocolates and heart-healthy red wine?  Stay away from those overpriced roses!




2 comments:

  1. If Bob were to have another heart attack six months later would we go back to using I21 for that episode or would we use I22 because it is not his first MI?

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    1. Great question! If Bob came back 6 months later with another heart attack, you would begin the process over with an I21 code. The I21 and I22 codes are only used for acute MIs that are within the 4 week period. But there is another code - I25.2, Old myocardial infarction - that you could add as a secondary code, which would let us know that the patient has had a heart attack before.

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