type 4 MI

Our coding department has questions about the type 4 MIs. If a patient had a stent placed 20 years ago and now presents with an MI due to in-stent thrombosis, is this still a type 4 MI? Does this need a query each time to clarify? We pick up the T code but are unsure if there is a time range on the stent placement for it to qualify for a type 4b MI. I've reviewed the ESC/ACCF/AHA/WHF Expert Consensus Document and feel that it leans toward no timeline. A 2 year old sent vs a 20 year old stent would both code to a type 4b MI if the in-stent thrombosis was the cause of the MI. We have sent the question to coding clinic and are awaiting a response. Just curious how everyone else codes these cases. Thanks!

Comments

  • I agree with you- I think this would be a type 4 MI- I see no description of timeline in the consensus. In my mind this makes sense as if you have an in stent thrombosis leading to an MI this definitely different then a coronary artery thrombosis of a vessel that has never been stented. 
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