Demand Ischemia or AMI Type 2

jlprinz@att.net

Greetings - I continue to struggle with the AMI Type 2 capture. So many variables. My question is best described in an example- Patient with elevated trop. NO chest pain/No EKG changes. Documentation states- demand ischemia due to 
(cause /infection/anemia/ renal ect)  I am wondering -when I should query for AMI Type 2?  My concern is when in a Cardiac MDC- it will capture as PDX and perhaps impact Readmission/Quality scores. 

Thank you -
CDE / MVH 

lprescott1

Type 2 MI describes an MI due to supply/demand mismatch, without plaque rupture, but also with myocardial necrosis evidenced by a rise of cardiac biomarkers in addition to at least one other criteria for MI. Providers use this term inconsistently, some meaning a myocardial infarction did occur, others to indicate an episode of demand ischemia. CDI Specialists may need to clarify the provider’s use of this term to assure proper code assignment. You should review the records for clinical indicators to support myocardial infarction and query as needed.

aimee_van balen_61052

Laurie is correct - i also would not query for demand type II NSTEMI based on your clinical indicators. Type II Demand NSTEMI should reveal a rise and fall in trops in addition to either chest pain or ischemic EKG changes. If a pt has a rise and fall of trops due to demand ischemia without chest pain/symptoms or EKG changes it *most likely* was not a true infarction.