News: Fourth universal definition of MI coming soon

By James S. Kennedy, MD, CCS, CCDS, CDIP

At the end of August, the fourth (and heavily revised) edition of the universal definition of myocardial infarction (MI) will be presented at the European Society of Cardiology meeting in Munich, Germany, with simultaneous publication in the Journal of the American College of Cardiology, Circulation, the European Heart Journal, and Nature Cardiology Reviews.

As described in a short article by Dr. Joseph Alpert of the University of Arizona in Tucson, this revision will emphasize the diagnostic criteria of Type 1, 2, 3, 4, and 5 MIs, the proper use and interpretation of highly-sensitive troponins, the mechanisms of ischemia with non-obstructive coronary arteries (INOCA), and MI with non-obstructive coronary arteries (MINOCA), and the identification of other pathophysiologies whereby troponin elevations should not be identified as an acute MI (AMI).  

Unfortunately, this article will emphasize the term “myocardial injury” in non-traumatic circumstances which will present tremendous CDI and coding challenges since ICD-10-CM only classifies this term as traumatic, requiring the physician to use alternative language. 

Previous AHA Coding Clinic advice published in 1992 regarding non-traumatic myocardial injury will also be confusing and challenging, given that the fourth universal definition of AMI emphasizes that “myocardial injury” is non-ischemic. 

I encourage all ACDIS members to develop a strategy to engage their cardiology and coding departments regarding this revised MI definition as to not unintentionally represent a patient has having an AMI in the circumstances of a physician’s documentation of “myocardial injury” when, in fact, he or she didn’t.

Editor’s note: Dr. Kennedy is a general internist and certified coder, specializing in clinical effectiveness, medical informatics, and clinical documentation and coding improvement strategies. Contact him at 615-479-7021 or at jkennedy@cdimd.com. Opinions expressed are that of the author and do not necessarily represent HCPro, ACDIS, or any of its subsidiaries.