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NSTEMI Type 2
A type 2 NSTEMI is secondary to ischemia from a supply-and-demand mismatch. Not related to coronary artery disease (thrombosis).
Treatment for a Type 2 MI consists of treating the underlying cause/condition. Once this is corrected the insult to the heart should improve/resolve.
In diagnosing a Type 2 MI, apply “Fourth Universal Definition of Myocardial Infarction” the patient will have a clinical condition that is known to increase the oxygen demand or decrease the oxygen supply. AND an elevated troponin level (with rise or fall,to a level above the 99th percentile reference limit):
20% rise or fall of “Consecutive Critically High Troponin”
OR
50% rise or fall of “Normal Value Troponin to Critically High Troponin Value”
In addition to elevated troponin level (rise or fall) there must be evidence of ONE of the following:
· Symptoms of myocardial ischemia (chest pain, shortness of breath, etc.)
· New ischemic ECG changes o Development of pathological Q waves
· Imaging evidence of new loss of viable myocardium or new regional wall motion abnormality in a pattern consistent with an ischemic etiology
CDI TIPS:
The etiology of the Type 2 MI should be linked to the diagnosis when known: Example: severe anemia, shock (hypovolemic/cardiogenic ), respiratory failure, tachyarrhythmias, HTN emergency, pulmonary embolism or critical illness.
If the definition is not met/or verbiage is NOT codable; a clarification query is required:
o “Type 2 event”
o “Type 2 ischemia”
o “Troponin elevation, trend flat no 20% increase or decrease. Patient without chest pain. Likely type II MI demand ischemia in setting of hypertensive urgency, acute dehydration, and infection”
o "Elevated troponin, likely demand from tachycardia and infection, likely not type 1 NSTEMI"
· CODEABLE: “ Type 2 NSTEMI” and “Type 2 MI”
References:
Coding Tip: Type 2 NSTEMI Reporting (hiacode.com)
http://www.onlinejacc.org/content/accj/early/2018/08/22/j.jacc.2018.08.1038.full.pdf
Myocardial Infarction ICD-10: What's New | Pinson & Tang (pinsonandtang.com)
November 6