Myocardial Infarction

erin.williamson

According to the I10 guidelines an MI can be coded from the I21 category if it is equal to or less than 4 weeks and the patient requires continued care.  We have had MI cases that were readmitted within 30 days with a different PDX and our coders are coding the MI as an MCC merely because they patient was on a betablocker/ACE.  As CDI we don't believe this is accurate; can you give us some direction as to further educate our coders....or maybe this is legit and we are incorrect. 

bbogda@morrishospital.org

We code as your coders do based on the Guidelines. 

ICD-10-CM Official Guidelines for Coding and Reporting

9. Chapter 9: Diseases of Circulatory System (I00-I99)

e. Acute myocardial infarction (AMI)

For encounters occurring while the myocardial infarction is equal to, or less than, four weeks old, including transfers to another acute setting or a postacute setting, and the patient requires continued care for the myocardial infarction, codes from category I21 may continue to be reported.

Melissa_Finucan_15853

I think the answer may be in the statement "requires continued care."  I am not certain it is to be interpreted that continued care is taking a beta blocker or ACE.  If the patient was re-admitted, even within the 4 weeks, from home to the hospital, then the care for this MI has not been continuous.  Our system would interpret continued care as hospital-rehab-SNF-hospital- skilled care to skilled care without a discharge to home. 

christinear17@msn.com

I would consider what the doctor would be thinking about in a patient that just had an MI. Would he be doing extra monitoring (EKG, VS, Tele, adjustment of meds, etc) because of concern for the recent MI? Then I would count it. If the patient came in for a completely unrelated condition, that does not have an affect on cardiac system, then no. Frankly I would lean toward using it more often than not. It helps if the MD writes what he is thinking as he orders tests, etc.

vparent@emhs.org

We sent this question to coding clinic and they declined to answer further stating the issue is currently under review by the Editorial Advisory Board for Coding Clinic (5/11/16). Following resolution by the EAB, we should receive a definitive response.

bbogda@morrishospital.org

The guideline does not say anything about the MI within 4 weeks of admission being related to the admit diagnosis.  I think that is making an assumption about the meaning of the guideline.  I also think that 'continue care' is not the same as 'continuous care'.  The guideline does not say the patient needs to be under 'continuous' care. 

angela.clayberg@mwhc.com

Is this right??  Patient admitted with upper extremity swelling -> ruled in DVT/Cellulitis -> pt had a recent STEMI (with in 28 days) -> DRG goes to 280.  Why does it still drive the DRG even though it isn't what brought the patient back to the hospital?  Thanks