myocardial injury vs demand ischemia vs Type 2 MI

How are people dealing with the new Myocardial injury code it seems to muddy the water further.

Type 2 MI is due to a supply demand mismatch, not a coronary occlusion.

From many conversations with other CDI, providers and cardiologist, i felt pretty confident in understanding and how to phrase the question to providers to make their decision. BECAUSE THEY DO NOT ALL AGREE, BUT we present the information and they decide.

  1. We confirm 99th percentile... so that was half of the needed criteria.
  2. meet one of 5 :

Demand ischemia was less than 99th percentile, OR not meeting any of the 5 criteria.

EKG changes, ECHOS, and Angiography are concrete, but what is a symptom of myocardial ischemia? only Chest pain? what about Silent MI?

This is the least concrete and dependent on the provider's judgement.

Per Mayo:


Some people who have myocardial ischemia don't have any signs or symptoms (silent ischemia).

When they do occur, the most common is chest pressure or pain, typically on the left side of the body (angina pectoris). Other signs and symptoms — which might be experienced more commonly by women, older people and people with diabetes — include:

  • Neck or jaw pain
  • Shoulder or arm pain
  • A fast heartbeat
  • Shortness of breath when you are physically active
  • Nausea and vomiting
  • Sweating
  • Fatigue

So when would Type 2 MI be appropriate? When Myocardial Injury? when demand ischemia?

Also the latest coding guidelines don't mention it.


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