Frequently, Type 2 MI is inconsistently documented.
February is American Heart Month, a time to raise awareness of cardiovascular health and a time to shine a light on cardiac issues, especially myocardial infarction (MI).
Unfortunately, every year about 805,000 people in the United States have a heart attack. Basically, someone has a heart attack every 40 seconds.
One type of MI that you often hear about is Type 2 MI. Clinical documentation improvement (CDI) and coding experts at Innova Revenue Group decided that this would be a perfect time to discuss the associated documentation and coding challenges.
Type 2 MIs are a common pain point for CDI departments. This is due to conflicting or lack of clinical indicators in provider documentation that requires further clarification with a query.
Type 2 MIs are frequently incorrectly diagnosed and inconsistently documented. Per The Fourth Universal Definition of MI, released in 2018 by the Journal of the American College of Cardiology, a Type 2 MI is diagnosed in the presence of elevated troponins, primarily due to a supply/demand imbalance without coronary thrombosis (i.e. not due to CAD and the presence of at least one of the following):
A Type 2 MI results from an imbalance between myocardial oxygen supply and demand, unrelated to acute coronary artery thrombosis or plaque rupture. A Type 2 MI is a relative (as opposed to an absolute) deficiency in coronary artery blood flow, triggered by an abrupt increase in myocardial oxygen demand, a drop in myocardial blood supply, or both. In a Type 2 MI, myocardial injury occurs secondary to an underlying process and therefore requires correct documentation of the underlying cause as well.
Common examples of underlying causes of Type 2 MI include acute blood loss anemia (e.g. a GI bleed), acute hypoxia (e.g. COPD exacerbation), shock states (cardiogenic, hypovolemic, hemorrhagic, or septic), coronary vasospasm (e.g. spontaneous), and bradyarrhythmia. Patients with Type 2 MI often have a history of fixed obstructive coronary disease, which when coupled with the acute trigger facilitates the Type 2 MI; however, underlying CAD is not always present.
Type 2 non-ST elevation myocardial infarction (NSTEMI) is also a problematic term for coders. According to coding guidelines, when Type 2 NSTEMI is documented, the code for Type 2 MI should be assigned and the code for NSTEMI should be withheld. If a coder incorrectly assigns the code for a NSTEMI – I21.4 – the case will be inappropriately pulled into the National Cardiovascular Data Registry and included in the Centers for Medicare & Medicaid Services (CMS) cohort for 30-day readmission rates and 30-day mortality rates.
As you can see, getting the provider to properly diagnose a Type 2 MI is extremely important. The one thing to keep in mind is that in a Type 2 MI, there is always demand ischemia. If you see the provider documenting a Type 2 MI without demand ischemia, a query should be issued to validate clinically the diagnosis. If there is no ischemia, another possible diagnosis is myocardial injury. This diagnosis was introduced in The Fourth Universal Definition of MI, which is defined by at least one cardiac troponin concentration above the 99th percentile URL. In 2022, a new code, I5A (Non-ischemic myocardial injury (non-traumatic)) was introduced into the ICD-10-CM classification system. Similar to coding a Type 2 MI, myocardial injury requires the underlying cause to be sequenced first.
It is crucial for clinical documentation integrity specialists (CDISs) to educate providers on Type 2 MIs and the importance of documenting the underlying cause. This will reduce the number of queries sent and get claims out the door quicker!
Programming note: Listen to Lidiya Ter-Markarova report this story live today during Talk Ten Tuesdays with Chuck Buck and Dr. Erica Remer, 10 Eastern.
As the November elections neared, you might have expected Washington to slow to a crawl amidst campaigning and uncertainty about the future. However, the show
The presidential election, pitting former President Donald Trump against Vice President Kamala Harris, has generated intense debate over the direction of healthcare policy. Despite the
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.
