cardiac cath

pt admitted for NSTEMI and CAD....  went to cath lab had 2 drug eluting stents placed.  Can you sequence the CAD as principle?


  • No..acute reason for admit is the NSTEM.
  • I agree - NSTEMI would be the PDX.  The patient went to the cath lab because of the NSTEMI which is also why the stents were placed.  Most likely, the pt already had CAD so this wasn't an acute issue.
  • what about unstable Angina as principle?
  • If NSTEMI present, angina is not coded.
  • edited November 2019

    If the patient had a previous cath with stents placed and they find in-stent restenosis related to thrombus, in that instance you would sequence the NSTEMI as a secondary based on coding clinic guidance but you would not use the CAD or USA as Pdx.   

    Non-ST elevation myocardial infarction secondary to stent thrombus

          ICD-10-CM/PCS Coding Clinic, Second Quarter ICD-10 2019 Pages: 32-33 Effective with discharges: June 21, 2019

  • Answer from Coding Clinic:

    Assign codes I97.190, Other postprocedural cardiac functional disturbances following cardiac surgery, T82.867A, Thrombosis due to cardiac prosthetic devices, implants and grafts, initial encounter, and I21.A9, Other myocardial infarction type. Code I97.190 is more specific to the postprocedural MI.


    IMO, NSTEMI would NOT be a secondary diagnosis.

    My question is that since NSTEMI would NOT be coded (due to postprocedure complication code being used), then would this example technically be a type 4b (confirmed stent thrombosis) MI and not be in the STEMI/NSTEMI Acute MI bucket for CMS MI Mortality Metric or National Cardiovascular Data Registry ?


  • edited April 2021

    NSTEMI is a diagnosis in comparing to angina that is sign/symptom

  • One does not code both unstable angina and NSTEMI

  • This an excellent observation and question. The Registry cited ‘should’ list the particular codes that meet the criteria?

  • Hello. Our coding department has just required that we query for the etiology of the in-stent re-stenosis- Progression of disease vs complication of the stent and if the MD answers disease progression we do not code the T code at all. Is this standard?

    Thank you

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