NSTEMI coding paging mitchellde

heartyoga

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I have an interesting case for y'all.

Patient was admitted to the hospital. Elevated troponin documented as "probably type 2 NSTEMI on 4/9/19. Patient was transferred to another hospital where cath was done showed no significant blockage but some cholesterol plaque.

Our doctor mentioned "probably non STEMI " on HPI. On assessments, he said "elevated troponin enzyme no significant blockage on cath).

We are having a debate here. Biller 1 wants to use I21.4 NSTEMI definition as partial obstruction of one or more coronary arteries that causes decrease blood flow and may cause partial thickeness necrosis of myocardial muscle cells. Seen in the office on 4/30/19 and therefore with 4 weeks of initial "MI".

Doctor said that if we bill I21.4 it would appear that the NSTEMI is still active, when in fact it is not and after cath, it is medically not NSTEMI with above definition.

Doctor said that I25.2 old MI defined as healed MI or past MI diagnosed by ECG or other investigation, but currently presenting no symptoms.

Biller 1 is a stickler for the coding guidelines which states it should be coded as I21.4 but in this case, old MI seems to be medically accurate.

Which one is correct?

Thanks everyone for clarification of this situation that stumps me.
 

Chelle-Lynn

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If the provider is stating that the MI is healed and the current condition is without blockage, then we would code that as I25.2. This comes down to the medical definition which is defined by the provider.

An MI is defined as: MI occurs when blood flow to an area of the heart muscle is severely diminished or entirely blocked due to a primary coronary event such as plaque erosion or rupture. In this case there is no diminished blood flow so MI would not apply as an active condition based on the physician assessment.
 

mitchellde

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I have an interesting case for y'all.

Patient was admitted to the hospital. Elevated troponin documented as "probably type 2 NSTEMI on 4/9/19. Patient was transferred to another hospital where cath was done showed no significant blockage but some cholesterol plaque.

Our doctor mentioned "probably non STEMI " on HPI. On assessments, he said "elevated troponin enzyme no significant blockage on cath).

We are having a debate here. Biller 1 wants to use I21.4 NSTEMI definition as partial obstruction of one or more coronary arteries that causes decrease blood flow and may cause partial thickeness necrosis of myocardial muscle cells. Seen in the office on 4/30/19 and therefore with 4 weeks of initial "MI".

Doctor said that if we bill I21.4 it would appear that the NSTEMI is still active, when in fact it is not and after cath, it is medically not NSTEMI with above definition.

Doctor said that I25.2 old MI defined as healed MI or past MI diagnosed by ECG or other investigation, but currently presenting no symptoms.

Biller 1 is a stickler for the coding guidelines which states it should be coded as I21.4 but in this case, old MI seems to be medically accurate.

Which one is correct?

Thanks everyone for clarification of this situation that stumps me.
I each instance where the provider documented the NSTEMI he prefaced it with the word probably. We do not code diagnosis that are documented as probably there for e you also would not code this as an old MI since it never was truly diagnosed. the only codeable diagnosis documented here is the elevated troponin enzyme.
 
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