Conference Committee Insights: Getting to the Heart of Accurately Defining Cardiac Ischemic Syndromes

By Deidre Barnett, MHCL, BSN, RN, CCDS

Editor’s note: Barnett is a CDI specialist at MedPartners HIM in Tampa, Florida. She was one of the 12 member 2017 Conference Committee. For more information regarding the conference committee and to apply for the 2018 committee, click here.

With CMS piloting the bundled payment for acute myocardial infarction (AMI), CDI efforts in clarifying cardiac conditions is a very hot topic right now so I was glad to attend “Getting to the Heart of Accurately Defining Cardiac Ischemia,” presented by Christopher M. Huff, MD, FACC, and Garry L. Huff, MD, CCS, CCDS. The discussion also ties right in with the recent Official Guidelines for Coding and Reporting which call for the assignment of a code Type 2 MI as an NSTEMI without needing this documentation from the provider—we used to have to query.

The father and son Huff team did an excellent job on both sides of the discussion. Review and explanation of the pathophysiology from a cardiologist delved into the nitty gritty of what meets criteria for an AMI. Review of related diagnoses that occur on the spectrum from ischemia, injury, and infarction were covered in detail. The CDI implications were well defined–citing the importance of clinical validation when the criteria are not met but also explaining how the potential query as related to other diagnoses will impact the SOI/ROM.

It’s important to understand that all AMIs should meet certain criteria to be classified as an AMI. Type 2 MI is sometimes difficult to classify since it has a different etiology than the typical Type 1 AMI caused by an embolus (either blood clot or atherosclerotic plaque). There is a spectrum of myocardial injury that rises to the level of infarction when the criteria are met.

Therefore, as CDI specialists, we learned that it’s important to review every record for the AMI criteria and query appropriately for validation (if the criteria do not appear to be met) or inclusion (if the criteria are met and the provider does not document the STEMI/NSTEMI).

It was invaluable to have the pathophysiology reviewed as well as the CDI opportunities addressed in the same presentation.