Coding Subsequent Care of MI

patricia.fountain

In the case of a patient who has had an AMI within 8 weeks, returns to the hospital for another reason having nothing to do with the MI, what if any are the Coding Guidelines saying about having to code subsequent care of an MI versus history of MI? If there is no care directed at the MI, should it be coded to subsequent care? One of my cardiologists is asking for an explanation.

Thanks so much for your help! Happy New Year!

evanspx@sutterhealth.org

I would state that an MI less than 8 weeks old is 'always reportable', even if/when no active intervention is required. It is a risk factor that would at least enter into 'medical-decision' making process of the clinician. The code would be: 410.X2 (X = location and 5th digit of '2' indicates subsequent episode of care).

If over 8 weeks, code as 412 - "all' coders report infarctions in this manner in order to fully tell a complete story, support ROM, Risk-Adjusted Outcomes, etc.

Rationale and Citations


AHA Coding Clinic® for ICD-9-CM, 2Q 2003, Volume 20, Number 2, Page 10

Question:
When is it appropriate to assign code 412, Old myocardial infarction, versus code 414.8, Other specified forms of chronic ischemic heart disease, as a secondary diagnosis to show any old myocardial infarction (MI)?

Answer:
Code 412, Old myocardial infarction, is a history code and should be reported to identify a “healed or old MI” whether the patient is currently experiencing problems or not. An old myocardial infarction is coded because it is significant and affects the management of the patient. The note under code 412 mentioning, “currently presenting no symptoms” refers to symptoms related to the previous old myocardial infarction, not cardiac symptoms in general.


AHA Coding Clinic®for ICD-9-CM, 4Q 1999, Volume 16, Number 4, Page 9

Question:
When a patient is transferred from a hospital to a nursing home for continued recovery following an acute inferior wall myocardial infarction, what is the principal diagnosis at the nursing home? Would this be considered a "subsequent episode of care?"

Answer:
Yes, this would be considered a subsequent episode of care. In this case, it would be appropriate to assign code 410.42, Acute myocardial infarction, unspecified site, subsequent episode of care, for the LTC admission.

Report as 410.X2 - Use fifth-digit 2 to designate an episode of care following the initial episode when the patient is admitted for further observation, evaluation or treatment for a myocardial infarction that has received initial treatment but is still less than 8 weeks old. Source: ICD-9-CM VOL. 1


The use of fifth-digit 1 is not limited to acute care transfers and includes transfers to long term care hospitals (LTCH) when the patient has not been discharged from medical care for the myocardial infarction and is within the specified time frame. Use the fifth digit 2 when the patient is being transferred to a non-acute facility (e.g., SNF, ICF, Home Health, Rehab, etc.). Source: CC 2Q 2006


Use fifth-digit 0 when the source document does not contain sufficient information for the assignment of fifth-digit 1 or 2. Use fifth-digit 1 to designate the first episode of care (regardless of facility site) for a newly diagnosed myocardial infarction. The fifth-digit 1 is assigned regardless of the number of times a patient may be transferred during the initial episode of care. Use fifth-digit 2 to designate an episode of care following the initial episode when the patient is admitted for further observation, evaluation or treatment for a myocardial infarction that has received initial treatment but is still less than 8 weeks old. Source: ICD-9-CM VOL. 1

Paul Evans, RHIA, CCS, CCS-P, CCDS
 
Manager, Regional Clinical Documentation & Coding Integrity
633 Folsom St., 7th Floor, Office 7-044
San Francisco, CA 94107
Cell:  415.637.9002
Fax:  415.600.1325
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evanspx@sutterhealth.org