MINOCA and INOCA: Twin Aspects of a Cardio Conundrum

MINOCA and INOCA: Twin Aspects of a Cardio Conundrum

The National Institutes of Health (NIH) recently reported MINOCA (myocardial infarction with non-obstructive coronary arteries) and INOCA (ischemia with non-obstructive coronary arteries) as non-conventional presentations of coronary syndromes that are increasingly recognized in the clinical arena, particularly with the availability of new cardiovascular imaging techniques. Both are related to heart failure (HF). MINOCA is not associated with benign outcomes, and HF is among the most prevalent events.

Regarding INOCA, microvascular dysfunction has also been found to be associated with HF, particularly with preserved ejection fraction (HFpEF).

The new Oct. 1 code set includes codes for the general condition of “CMD-Coronary Microvascular Dysfunction” and the symptoms and other conditions it can cause. This may be new to you, or you may have already seen this terminology in your facility.

Coronary microvascular dysfunction (or CMD) refers to the “microvasculature” (tiniest blood vessels) of the heart, which supply blood flow to the heart. CMD restricts the blood flow to the myocardium and increases the resistance in the microvasculature. The microvasculature can be as small as a human hair, and cannot be assessed with a cardiac catheterization. This tiny network of vessels is downstream from the epicardial vessels, which are larger and well-known, such as the left anterior descending artery and right coronary artery (which can be seen with a cardiac catheterization).

When a patient presents with symptoms with diagnostic evidence of angina, ischemia, or myocardial infarction, and a cardiac catheterization is performed that shows no blockages in the larger epicardial vessels, it may be that the blockage or other problem is in the microscopic vessels that cannot be seen during the cardiac catheterization.

INOCA is defined as patients with angiographic evidence of ischemia, but no obstructive coronary artery disease (CAD) at coronary angiography. The prevalence of INOCA has increased over the past decade and is estimated to affect 3-4 million individuals, with a female predominance. This condition has been associated with increased adverse clinical outcomes, recurrent hospitalization, additional procedures, decline in quality of life, and mortality, as compared to healthy individuals.

MINOCA is increasingly being recognized as a leading cause of ischemic heart disease (IHD). Notwithstanding the increasing interest, MINOCA remains a puzzling clinical entity that can be classified by distinguishing different underlying mechanisms, which can be divided into atherosclerotic and non-atherosclerotic categories. In particular, coronary microvascular dysfunction (CMD), classifiable in non-atherosclerotic mechanisms, is a leading factor with MINOCA.

Genetic susceptibility may have a role in CMD. However, few results have been obtained for understanding the genetic mechanisms underlying CMD. Future studies are essential to find a deeper understanding of the role of multiple genetic variants in the genesis of microcirculation dysfunction.

The major difference between MINOCA and INOCA is that the former requires evidence of acute myocardial infarction, and at the same time, angiographic proof of non-occlusive coronary disease. With new codes for 2024, we will be contributing to the data available to monitor this condition and support further research of innovative treatment modalities.

Look for documentation to indicate CMD as the cause of any of these conditions.

The new coding for CMD and the related conditions include:

ANGINA
  • New code-I20.81- Angina pectoris with coronary microvascular dysfunction
INOCA-Ischemia with non-obstructive coronary arteries
  • New code-I24.81-Acute coronary microvascular dysfunction 
  • New code-I25.85-Chronic coronary microvascular dysfunction
DOCUMENTATION GUIDANCE-Educate physicians to document acute or chronic.
  • Code I24.8-Other forms of acute ischemic heart disease were expanded to I24.89 to accommodate the addition of a fifth character to Category I24.8             
MINOCA-Myocardial infarction with non-obstructive coronary arteries
  • New code I21.B- Myocardial infarction with coronary microvascular dysfunction (Myocardial Infarct with non-obstructed Coronary Arteries-MINOCA)

Remember that there is other documented evidence that a patient had a myocardial infarction, such as chest pain, high-sensitivity troponin elevation trend, and EKG evidence when the cardiac catheterization is not conclusive for the myocardial infarction by a blockage in the larger vessels.


For visual images, this URL may be of interest:https://medicaldialogues.in/cardiology-ctvs/news/tmt-has-limited-sensitivity-to-detect-coronary-microvascular-disease-finds-study-83073 Go to images.

Print Friendly, PDF & Email
Facebook
Twitter
LinkedIn

Pamela Scott, RHIT, CCS, CCDS, CRC, AHIMA-Approved ICD-10 CM/PCS Trainer

Pam provides coding support and coding compliance services for our clients. She has served as a coding mentor to many of our clients’ coders and especially those new to the coding field. Our clients often compliment her on her caring attitude and quality of her work. Certified in risk-adjustment coding (HCCs), Pam has participated in governmental audits of Medicare Advantage plans and can assist clients in understanding the nuances of this coding system

Related Stories

Leave a Reply

Please log in to your account to comment on this article.

Featured Webcasts

2024 Observation Services Billing: How to Get It Right

2024 Observation Services Billing: How to Get It Right

Dr. Ronald Hirsch presents an essential “A to Z” review of Observation, including proper use for Medicare, Medicare Advantage, and commercial payers. He addresses the correct use of Observation in medical patients and surgical patients, and how to deal with the billing of unnecessary Observation services, professional fee billing, and more.

March 21, 2024
Top-10 Compliance Risk Areas for Hospitals & Physicians in 2024: Get Ahead of Federal Audit Targets

Top-10 Compliance Risk Areas for Hospitals & Physicians in 2024: Get Ahead of Federal Audit Targets

Explore the top-10 federal audit targets for 2024 in our webcast, “Top-10 Compliance Risk Areas for Hospitals & Physicians in 2024: Get Ahead of Federal Audit Targets,” featuring Certified Compliance Officer Michael G. Calahan, PA, MBA. Gain insights and best practices to proactively address risks, enhance compliance, and ensure financial well-being for your healthcare facility or practice. Join us for a comprehensive guide to successfully navigating the federal audit landscape.

February 22, 2024
Mastering Healthcare Refunds: Navigating Compliance with Confidence

Mastering Healthcare Refunds: Navigating Compliance with Confidence

Join healthcare attorney David Glaser, as he debunks refund myths, clarifies compliance essentials, and empowers healthcare professionals to safeguard facility finances. Uncover the secrets behind when to refund and why it matters. Don’t miss this crucial insight into strategic refund management.

February 29, 2024
Mastering Medicare Notices: Your Essential Guide to the MOON and Beyond

Mastering Medicare Notices: Your Essential Guide to the MOON and Beyond

Hospital staff continue to grapple with the complexities of Medicare notices.  In this webcast, Tiffany Ferguson, LMSW, CMAC, ACM, will present the latest requirements for preparation and delivery of CMS-mandated forms, including the Advance Beneficiary Notice (ABN), Hospital-Issued Notices of Noncoverage (HINNs), Important Message from Medicare (IMM) and Medicare Outpatient Observation Notice (MOON), and practical solutions through foolproof workflows and compliance auditing.

January 25, 2024
OBGYN ICD-10-CM/PCS Coding: Mastering Complex Guidelines and Compliance

OBGYN ICD-10-CM/PCS Coding: Mastering Complex Guidelines and Compliance

Dive into the complexities of Obstetrics and Gynecology coding, addressing challenges from antepartum to postpartum care. Learn to decode intricate guidelines, tackle claim denials, and safeguard your practice’s financial health. Uncover the secrets to compliant coding, reducing errors, and optimizing reimbursement. With practical exercises and expert insights, this webcast empowers coders, auditors, and healthcare professionals to elevate their OBGYN coding prowess.

February 28, 2024
Unlocking Clinical Documentation Excellence: Empowering CDISs & Coders

Unlocking Clinical Documentation Excellence: How to Engage the Provider

Uncover effective techniques to foster provider understanding of CDI, empower CDISs and coders to customize their queries for enhanced effectiveness, and learn to engage adult learners, leveraging their experiences for superior learning outcomes. Elevate your CDI expertise, leading to fewer coding errors, reduced claim denials, and minimized audit issues.

December 14, 2023
Coding for Spinal Procedures: A 2-Part Webcast Series

Coding for Spinal Procedures: A 2-Part Webcast Series

This exclusive ICD10monitor webcast series will help you acquire the critical knowledge you need to completely and accurately assign ICD-10-PCS and CPT® codes for spinal fusion and other common spinal procedures.

October 26, 2023

Trending News

It’s Heart Month! Use code HEART24 at checkout to receive 20% off your cardiology products. Click here to view our suite of Cardiology products!