Wiki Post infarction angina. paging mitchellde

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heartyoga

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Patient was admitted to the hospital with shortness of breath, tests showed elevated troponin. He has a history of old infarct involving old inferoapical area.
Doctor had the dx of NSTEMI, Type 2. Cath a few days later showed mild diffuse disease of LAD, RCA, and circumflex artery.

Patient came back to our clinic 27 days after hospitalization, initial dx of NSTEMI.
Doctor had dx CAD.

Coder came back saying that she will be coding it still as NSTEMI and complaining why the doctor never mentioned it is still NSTEMI.
She also said that if patient has angina, she would need to code it as post infarction angina.
Doctor had explained that medically post infarction angina is a rare occurrence in 10-15% of cases.

I felt like CAD w stable angina I25.118 as documented is more appropriate.

The doctor has felt that CAD would include the new mild arterial diseases and the old MI.

Is CAD appropriate to code?

Thanks for helping us learn something new every day.
 
the Acute MI is still coded as NSTEMI or STEMI up to 4 weeks post infarction. That is up to 28 days after the date of onset not 28 days post hospitalization. Coding guidelines:
For encounters occurring while the myocardial infarction is equal to, or less than, four weeks old, including transfers to another acute setting or a postacute setting, and the myocardial infarction meets the definition for “other diagnoses” (see Section III, Reporting Additional Diagnoses), codes from category I21 may continue to be reported. For encounters after the 4 week time frame and the patient is still receiving care related to the myocardial infarction, the appropriate aftercare code should be assigned, rather than a code from category I21. For old or healed myocardial infarctions not requiring further care, code I25.2, Old myocardial infarction, may be assigned.
So if this is more than 28 days past the date of onset then you would not use the code for the NSTEMI you would use either a Z code for the aftercare if it is still being managed or the I25.2 for old MI.
If the provider feels all is good and is treating and managing only the underlying CAD to prevent further episodes then code the CAD and then the I25.2.
If you look up the code for post infarction angina you will see it is in the I23 category, these codes are restricted to conditions within the 28 day timeframe from the date of onset of the MI. If the 28 days has expired and the provider indicates angina then do not code it as post infarction.
 
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