Diagnostic Coding for Type 2 Myocardial Infarction

Regarding coding for Type 2 Myocardial Infarction, per Coding Clinic (1st Quarter 2017):

Question: If a provider documents type 2 myocardial infarction (T2MI) due to demand ischemia, how should it be
coded?
Answer: Assign code I21.4, Non-ST elevation (NSTEMI) myocardial infarction, for a T2MI. Typically, a type 2 myocardial infarction is marked by non-ST elevation, and occurs secondary to cardiac stress due to other causes (i.e., ischemia resulting from a supply-and-demand mismatch), without atherosclerotic plaque rupture, but with myocardial necrosis. Therefore, code a type 2 myocardial infarction as a NSTEMI, unless otherwise documented as STEMI.

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John Verhovshek

John Verhovshek, MA, CPC, is a contributing editor at AAPC. He has been covering medical coding and billing, healthcare policy, and the business of medicine since 1999. He is an alumnus of York College of Pennsylvania and Clemson University.

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