Coding, Classification & Reimbursement

STEMI and NSTEMI ICD 10 CM

  • 1.  STEMI and NSTEMI ICD 10 CM

    Posted 12-14-2018 10:27
    Our coworkers and i have a question regarding a STEMI with Subsequent NSTEMI.

    Let me try to be as clear as possible so y'all can understand me.

    This patient came in with an Acute inferior ST segment elevation MI.
    LHC was done, angioplasty and stenting to the RCA and LAD was done.
    4 days later patient is having chest pain with EKG changes and reveal an NSTEMI.
    Another LHC was done with angioplasty and stenting again to the LAD. Previous stents were wide open just significant disease on the proximal and midportion.

    Our question is we based on the ICD 10 Guidelines; A code from category I22, Subsequent ST elevation (STEMI) and non-ST elevation (NSTEMI) myocardial infarction, is to be used when a patient who has suffered a type 1 or unspecified AMI has a new AMI within the 4 week time frame of the initial AMI. A code from category I22 must be used in conjunction with a code from category I21.

    By using I22.2 Subsequent NSTEMI myocardial infarction we are saying that at first patient had a NSTEMI instead of STEMI.
    so we are thinking that is better to code as I21.4? What are your thoughts?

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    Bianca Leal, CCS
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  • 2.  RE: STEMI and NSTEMI ICD 10 CM

    Posted 12-15-2018 14:27
    Hello,
       This has been a challenge to me also.  I would assign code I21.11 for the STEMI(type 1)- reason for admission .
    Per the Coding 2019 guidelines says " if a subsequent MI of one type occurs within 4 weeks of MI of a different type , assign the appropriate codes from category I21 to identify each type. Do not assign a code from I22. Codes from category I22 should only be assigned if both the initial and subsequent MI s are type I or unspecified. In summary as both the MI,s are different type MI,s both MIs would be coded. You would not need the I22 code. That is my interpretation of the ICD10 Guidelines . Hope this helps💥Jan Dupre RHIT CCS AHIMA Icd10 Trainer

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    [Jan ] [Dupre RHIT CCS AHIMA Trainer]
    [Coding Consultant]
    [Trinity Coding Solutions,Inc]
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  • 3.  RE: STEMI and NSTEMI ICD 10 CM

    Posted 12-16-2018 10:26
    I did not see where the NSTEMI was documented as being a type 2, therefore both the initial STEMI and the subsequent NSTEMI would be coded. Guidelines state: "Do not assign code I22 for subsequent myocardial infarctions other than type 1 or unspecified",  also states: "A code from category I22 must be used in conjunction with a code from category I21. The sequencing of the I22 and I21 codes depends on the circumstances of the encounter." Sounds like the patient was admitted for the STEMI and had the NSTEMI later, so I recommend sequencing the STEMI as PDX and the NSTEMI as a secondary diagnosis.

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    Karen Neal
    Coding Quality Auditor
    Conifer Health Solutions
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  • 4.  RE: STEMI and NSTEMI ICD 10 CM

    Posted 12-17-2018 00:42
    I forgot to add that the STEMI code (121.-) would be PDX and the NSTEMI would be coded as a secondary code-subsequent I22.2.

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    Karen Neal
    Coding Quality Auditor
    Conifer Health Solutions
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  • 5.  RE: STEMI and NSTEMI ICD 10 CM

    Posted 12-17-2018 13:53
    Karen is correct,
    I21 STEMI was the reason for admission, so that's the PDX.
    NSTEMI was the subsequent (second) event and occurred after admission, so I22 is the secondary dx. As stated above, it is not documented as a different "type".
    The terminology can be a little confusing until you really stop and work through it.
    Hope that helps.
    Lorraine

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  • 6.  RE: STEMI and NSTEMI ICD 10 CM

    Posted 12-17-2018 08:05
    The guideline states: Codes from category I22 should only be assigned if both the initial and subsequent myocardial infarctions are type 1 or unspecified.  Both MIs in your scenario appear to be type 1.  The guideline is referring to MI that is a type 2-5.

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    Nancy Martilik
    Asst. Director of Education
    Health Information Associates
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  • 7.  RE: STEMI and NSTEMI ICD 10 CM

    Posted 12-17-2018 08:33
    Thank you so much for answering. I see y'all point in coding the subsequent I22 since both are considered type 1 and is within 4 weeks.
    But this is how we read it, if i code the STEMI and then the I22.2 Subsequent NSTEMI. It seem that i'm coding if the patient first had a NSTEMI at first and not a STEMI? The Subsequent NSTEMI is throwing us off.

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    Bianca Leal, CCS
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  • 8.  RE: STEMI and NSTEMI ICD 10 CM

    Posted 30 days ago
    "Subsequent NSTEMI" means that the 2nd MI was NSTEMI. It does not matter what?the?first?MI?was.
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