Cardiology Coding Alert
I21.- Will Replace 410.1x and Add Artery Involvement to Your Documentation Needs
See whether episode of care determines fifth digit under ICD-10 2011.
Each day brings the Oct. 1, 2013, transition to ICD-10 a little closer. To smooth the transition, we're featuring an overview each month of codes you're likely to use in your practice. This month, take a look at how ICD-9 and ICD-10 codes for acute myocardial infarction (AMI) compare.
ICD-9: Your 2011 ICD-9 coding options for AMI classified as STEMI (ST elevation MI) are as follows:
For a non-STEMI (NSTEMI), you report 410.7x (... subendocardial infarction). subendocardial infarction).
Your fifth digit options for these codes are:
0-- ... episode of care unspecified
1-- ... initial episode of care
2-- ... subsequent episode of care.
ICD-10: ICD-10 2011 also breaks your coding options down based on STEMI and NSTEMI, and it actually uses those terms in the code descriptors. But your fifth digit options for I21.0-I21.2 depend on the arteries involved:
For NSTEMI, the code is I21.4 (Non-ST elevation [NSTEMI] myocardial infarction). Be sure to read the notes with each code. For example, a note under I21.21 tells you that it's appropriate for STEMI involving the oblique marginal coronary artery.
Bonus tip: Also review ICD-10 category I22 (Subsequent ST elevation [STEMI] and non-ST elevation [NSTEMI] myocardial infarction). Among the "includes" list for this range are recurrent MI and AMI's occurring within 28 days of a previous AMI. To report an I22 code, you must report an I21 code, as well. If the encounter is for the subsequent MI, sequence I22.- first. But if the subsequent MI occurs during the encounter for the initial MI, sequence I21.- first.
Takeaway: Analyze your current documentation to see if it's specific enough to allow you to choose a code based on the wall and the artery involved. Also determine whether you can easily locate the information in the file that you're instructed to use an additional code for. If not, alert the clinical staff to the increased documentation details and create tools that you can use for AMI patients that will allow clinical staff to easily gather the information you need.
Remember: When ICD-10 goes into effect on Oct. 1, 2013, you should apply the codes and official guidelines in effect at that time (or more specifically, always use the codes and guidelines effective for the relevant date of service). Learn more at www.cms.gov/ICD10/ and www.cdc.gov/nchs/icd/icd10cm.htm#10update.
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