Q&A: MI coding FAQs, part 2

Q: If a patient is admitted with a gastrointestinal bleed (self-limiting, no treatment/procedures performed or medication changes) within four weeks of the myocardial infarction (MI), would a code from category I21, Acute MI, be coded?

A: If an MI has occurred within the last 28 days, it has to meet the definition of a secondary diagnosis in order to be coded as an MI for that admission as does any diagnosis. Because in this scenario, there is no subsequent MI mentioned, coding would depend on the type of the initial MI that is still being treated, evaluated, etc. during the current admission.

If an old or healed MI is no longer requiring further care, assign code I25.2.

I want to point out that having an acute MI puts a patient at risk for having another MI, heart failure, arrythmias, valve issues such as regurgitation, cardiomyopathy, etc., and increases the patient’s risk of mortality. The heart muscle must heal, and it does take time and there are times when there’s irreversible damage from an acute MI, so the fact that a recent MI has occurred is clinically significant as long as it meets the definition of a secondary diagnosis.

Editor’s Note: Dawn Valdez, RN, LNC, CDIP, CCDS, CDI education specialist and CDI Boot Camp instructor for HCPro in Middleton, Massachusetts, answered this question. For information, contact her at dvaldez@hcpro.com. For information regarding CDI Boot Camps, click here. To read the first part of this Q&A, click here.