Type 2 NSTEMI

Hello,

Thought,obstacles,successes in querying for type 2 MI?
Does your institution have any formal or informal agreement on thr topic? Trogon in value, keg change, echo-wall motion... Ischemic signs...is chest pain itself with elevated troop in indicative...?greater than 0.5? 99th percentile... 3x upper limit of normal,I.e 0.12-0.18.

Buy in.... Hospital it's vs cardiologist?

Thanks,
Ann

Comments

  • I am familiar but still don't tend to get agreement often from cardiology.

    Chest pain troponin 0.82
    Is the chest pain itself considered sign of ischemia?

    Even with inverted t, or wall motion abnormality they don't agree.

    I wondered if this was unique or many others see similar...


  • Query:
    On DATE documentation in the NOTE TYPE section of the medical record indicates the patient ***. Evaluation and treatment includes: ***

    Please clarify the nature of the patient’s cardiac status.

    You may answer this Query by marking the checkbox(es) below or using free text at the ( * ) if appropriate.

    Provider Query Response:*

    Acute coronary syndrome without AMI
    Non ST elevation MI (NSTEMI)
    ST elevation MI
    Unable to determine
    Other (please specify)*

    If NSTEMI or STEMI, state if:

    Due to “IN-STENT RESTENOSIS” of cardiac stent



    NOTE IF ANY:
    Significant atherosclerosis present in autologous biological bypass graft
    Significant atherosclerosis present in non-autologous biological bypass graft
    Significant atherosclerosis present in graft of internal mammary artery
    Bundle branch blocks
    Ventricular tachycardia
    Right ventricular infarct
    Pericarditis
    Cardiogenic shock
    Cardiac tamponade
    Congestive heart failure

    The purpose of this query is to ensure accurate coding, severity of illness and risk of mortality compilation. When responding to this query, please exercise your independent professional judgment. The fact that a question is asked does not imply that any particular answer is desired or expected.



    Acute Myocardial Infarction Definitions
    The following definitions, reviewed by physician subject-matter experts, are offered as a reference

    Third Universal Definition of Myocardial Infarction, Circulation, October 16, 2012

    The term acute myocardial infarction (MI) should be used when there is evidence of myocardial necrosis in a clinical setting consistent with acute myocardial ischaemia.

    Under these conditions any one of the following criteria meets the diagnosis for MI:

    · Detection of rise and/or fall of cardiac biomarker values [preferably cardiac troponin (cTn)] with at least one value above the 99th percentile upper reference limit (URL) and at least one of the following:

    o Symptoms of ischaemia.

    o New or presumed new significant St-segment-T wave (ST-T) changes or new left bundle branch block (LBBB).

    o Development of pathological Q waves in the ECG.

    o Imaging evidence of new loss of viable myocardium or new regional wall abnormality.

    o Identification of an intracoronary thrombus by angiocardiograpy or autopsy.



    Paul Evans, RHIA, CCS, CCS-P, CCDS

    Manager, Regional Clinical Documentation
    Sutter West Bay
    633 Folsom St., 7th Floor, Office 7-044
    San Francisco, CA 94107
    Cell: 415.412.9421



    evanspx@sutterhealth.org


  • I can look more but if you have chest pain and elevated troponin that increased why wouldn't it meet nstemi?
    Upper limit in our lab is 0.06. Dcd a week before for chf with troponin if less than 0.01...

    I guess I thought st abnormalities could be present but ST elevations in specific lead would be STEMI ...


  • Our cardiologist are ‘on board’ with definitions cited by Dr. Gold and cited in the journal of Circulation.

    Paul Evans, RHIA, CCS, CCS-P, CCDS

    Manager, Regional Clinical Documentation
    Sutter West Bay
    633 Folsom St., 7th Floor, Office 7-044
    San Francisco, CA 94107
    Cell: 415.412.9421



    evanspx@sutterhealth.org


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