Impact of NSTEMI versus NSTEMI, Type 2

Can someone succinctly discuss the impact of reporting a NSTEMI versus reporting a NSTEMI, type 2, in regards to ROM and any impact on quality measures?


  • Using the code specific to NSTEMI Type 2- I21.A1 as the principal diagnosis removes the account from AMI quality measures.
  • Please correct me if I am wrong and clarify CC MCC issue.

    The markers* CK MB and Troponin make a difference here. So, if these markers, are above the 99th percentile of the reference range**(a population based statistic)  the diagnosis has to be NSTEMI or Type 2 MI; but,If less than the 99th percentile with supply vs demand miss match,and no evidence of Coronary Artery Disease( CAD)- just demand ischemia.

     No CAD(atherosclerotic plaques in PCI or angiogram) but  markers above 99th percentile and has reason to believe supply does not meet demand, physician is treating the underlying cause*** - would take our diagnosis towards type 2 MI. On the other hand,no CAD,markers below the 99th percentile with evidence of demand ischemia, the diagnosis would be- demand ischemia  

     Moreover, the 99th percentile for troponin I - 0.04mcg/L. 

    In a CDI's mind set,and looking towards the financial impact I assume just demand ischemia is CC (this fact I haven't got a chance to go on encoder to confirm)while other two are MCC .-if someone can verify , please post it here)

     Dr Kennedy's August journal article mentions everything I said here, except CC/MCC issue which is very important from CDI's standpoint. Still, with what I remember the encoder connects demand ischemia and type 2 MI at some point. Please verify this too. I was told during my training "code type 2 MI if physician documented demand ischemia."


    *An insult to the myocardium releases biomarkers(CK-MB and Troponin) correlate to the severity of the insult. 

     ** a population based statistic, two standard deviations from the mean in patient not known to have the condition related to the test-here,CK-MB and Troponin

    ***Causes for demand ischemia/supply demand mismatch - anemia, hypovolemia, shock, coronary vasospasm, .... 


    Dr.Kennedy's  August journal article.

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