ICD-10 code I21.A1 identifies Type 2 MI.
Over the past two months, I have been making the rounds speaking at regional and national conferences and going on-site for my consulting business. Many of you have approached me and assured me that the message I am trying to convey is indeed the message you are receiving.
I am not about the money – I am intent on getting providers to document accurately, specifically, and sufficiently to take excellent care of patients and to demonstrate how sick and complex they are. This optimizes quality metrics and reimbursement while preventing unwarranted hospital-acquired conditions (HACs) and patient safety indicators (PSIs). I never endorse exaggerating or upcoding. I believe I am actually quite conservative. I’d rather get it right up front than to have to fight a denial on the back end.
On June 20, I did a webinar on myocardial infarction (MI) – which, of course, included Type 2 myocardial infarctions. There has been some pushback from some individuals who decry the existence of this clinical entity and feel it is a “made-up diagnosis” that serves to jack up the DRG. They believe using it undermines the credibility of physician advisors and even have suggested that it harms patients.
Recently, our good friend Ron Hirsch (Ronald Hirsch, MD) brought to my attention an article in Circulation published online June 11, titled, “Type 2 Myocardial Infarction – Diagnosis, Prognosis, and Treatment,” by Cian McCarthy et. al. out of Massachusetts General Hospital and Brigham and Women’s Hospital. This article validated my viewpoint that Type 2 myocardial infarction is clinically relevant and important.
Their conclusion is this: “the diagnosis of Type 2 MI is associated with a poor prognosis: less than 40 percent of patients will live five years past their diagnosis.” They go on to explain that the poor prognosis is not surprising, because “Type 2 MI typically occurs among older patients with greater comorbidities and is identified in the context of hemodynamic instability.” The article goes on to note that “most deaths among patients with Type 2 MI are due to non-cardiovascular causes,” but that “approximately 30 percent of patients will have a cardiovascular event over five years,” which may even exceed that for patients with Type 1 MIs.
The article notes that there is precious little data and evidence-based guidelines regarding Type 2 MI. I am certain the fact that we didn’t have a way to separate out Type 2 MI from Type 1 MI in the ICD-10-CM code set strongly contributed to this shortfall. This was resolved in October 2017, when we got the unique code I21.A1 identifying Type 2 MI. We are now in a better position to be able to determine whether Type 2 MI demands its own treatment, or as has been the case in the past, you just treat the underlying condition. Insurance companies will have the ability to adapt their actuarial analyses, if needed.
I never recommend diagnosing and documenting conditions that are not present. I just want providers to practice excellent medicine and not to miss diagnosing and documenting conditions that are present. I say it harms patients if you don’t pick up the Type 2 MI, because it portends a worse prognosis. As Hippocrates would say, “primum non nocere” (first, do no harm).
Program Note:
Listen to Dr. Remer every Tuesday on Talk Ten Tuesday, 10 a.m. ET.
EDITOR’S NOTE: With Halloween on the radar, ICD10monitor Contributor Christine Geiger, Assistant Vice President of Acute and Post-Acute Coding Services for the St. Louis-based First
Wrapping up our discussion of the ICD-10-CM and PCS code updates released on Oct. 1, in this article we will examine some PCS-related changes. I
Please log in to your account to comment on this article.
Join Angela Comfort, DBA, MBA, RHIA, CDIP, CCS, CCS-P, as she presents effective strategies to strengthen collaboration between CDI, coding, and quality departments in acute care hospitals. Angela will also share guidance on implementing cross-departmental meetings, using shared KPIs, and engaging leadership to foster a culture of collaboration. Attendees will gain actionable tools to optimize documentation accuracy, elevate quality metrics, and drive a unified approach to healthcare goals, ultimately enhancing both patient outcomes and organizational performance.
Optimize your outpatient clinical documentation and gain comprehensive knowledge from foundational practices to advanced technologies, ensuring improved patient care and organizational and financial success. This webcast bundle provides a holistic approach to outpatient CDI, empowering you to implement best practices from the ground up and leverage advanced strategies for superior results. You will gain actionable insights to improve documentation quality, patient care, compliance, and financial outcomes.
Enhancing outpatient clinical documentation is crucial for maintaining accuracy, compliance, and proper reimbursement in today’s complex healthcare environment. This webcast, presented by industry expert Angela Comfort, DBA, RHIA, CDIP, CCS, CCS-P, will provide you with actionable strategies to tackle complex challenges in outpatient documentation. You’ll learn how to craft detailed clinical narratives, utilize advanced EHR features, and implement accurate risk adjustment and HCC coding. The session also covers essential regulatory updates to keep your documentation practices compliant. Join us to gain the tools you need to improve documentation quality, support better patient care, and ensure financial integrity.
This webcast, presented by Angela Comfort, DBA, RHIA, CDIP, CCS, CCS-P, a recognized expert with over 30 years of experience, offers essential strategies to improve outpatient clinical documentation integrity. You will learn how to enhance the accuracy and completeness of patient records by adopting best practices in coding and incorporating Social Determinants of Health (SDOH). The session also highlights the role of technology, such as EHRs and CDI software, in improving documentation quality. By attending, you will gain practical insights into ensuring precise and compliant documentation, supporting patient care, and optimizing reimbursement. This webcast is crucial for those looking to address documentation gaps and elevate their coding practices.
Dr. Ronald Hirsch provides critical details on the new Medicare Appeal Process for Status Changes for patients whose status changes during their hospital stay. He also delves into other scenarios of hospital patients receiving custodial care or medically unnecessary services where patient notifications may be needed along with the processes necessary to ensure compliance with state and federal guidance.
Healthcare organizations face complex regulatory requirements under the No Surprises Act and Price Transparency rules. These policies mandate extensive fee disclosures across settings, and confusion is widespread—many hospitals remain unaware they must post every contracted rate. Non-compliance could lead to costly penalties, financial loss, and legal risks. Join David M. Glaser Esq. as he shows you how to navigate these regulations effectively.
Protect your facility from unwanted audits! Join Becky Jacobsen, BSN, RN, MBS, CCS-P, CPC, CPEDC, CBCS, CEMC, and take a deep dive into both the CMS and AMA guidelines for reporting post operative pain blocks. You’ll learn how to determine if the nerve block is separately codable with real life examples for better understanding. Becky will also cover how to evaluate whether documentation supports medical necessity, offer recommendations for stronger documentation practices, and provide guidance on educating providers about documentation requirements. She’ll include a discussion of appropriate modifier and diagnosis coding assignment so that you can be confident that your billing of post operative pain blocks is fully supported and compliant.
During this RACmonitor webcast Dr. Ronald Hirsch spotlights the areas of the OIG’s Work Plan and the findings of their most recent audits that impact utilization review, case management, and audit staff. He also provides his common-sense interpretation of the prevailing regulations related to those target issues. You’ll walk away better equipped with strategies to put in place immediately to reduce your risk of paybacks, increased scrutiny, and criminal penalties.
Copyright © 2024 ICD10monitor. Powered by MedLearn Media.
Prepare for the 2025 CMS IPPS Final Rule with ICD10monitor’s IPPSPalooza! Click HERE to learn more
Get 15% OFF on all educational webcasts at ICD10monitor with code JULYFOURTH24 until July 4, 2024—start learning today!
👻Spooky Sale is Back!👻 Get 31% off all three Medlearn brands, using code SPOOKY24.
