Comments on the proposals for 2018 are due April 7, 2017. This article provides more detail on two subjects – types of myocardial infarctions (MI) and heart failure classifications.
The types of myocardial infarctions are based on the American College of Cardiology (ACC) categorization.
- Type 1 indicates that the patient has evidence of spontaneous plaque rupture or erosion in an epicardial coronary vessel.
- Type 2 indicates that the MI is due to either increased oxygen demand or decreased supply (e.g. coronary artery spasm, coronary embolism, anemia, arrhythmia, hypertension, hypotension, etc.).
- Type 3 indicates that the MI resulted in sudden death.
- Type 4a indicates that the MI is associated with percutaneous coronary intervention (PCI) within 48 hours of the procedure.
- Type 4b indicates that the MI is associated with in-stent thrombosis.
- Type 4c indicates that the MI is associated with restenosis of a PCI.
- Type 5 is an MI associated with a coronary artery bypass graft (CABG) within 48 hours of the procedure.
The proposal for heart failure classifications is based on those used by the ACC as well as the American Heart Association. The entities use stages of A, B, C, and D. The New York Hospital Association classifications have not been included in this proposal.
The heart failure stages are defined as:
- Stage A – the patient has a presence of risk factors, but is asymptomatic. The code assigned should be Z91.89, other specified personal risk factors, not elsewhere classified.
- Stage B – heart disease is present, but there are no symptoms. There are structural changes to the heart present.
- Stage C – structural heart disease is present with symptoms.
- Stage D – the patient is in end-stage heart failure with advanced structural heart disease and pronounced symptoms of heart failure at rest or upon minimal exertion.
Comments regarding the proposed diagnosis and procedure codes are due on April 7 for the codes for which expedited action has been requested. Comments regarding ICD-10-CM can be emailed to the Centers for Disease Control and Prevention (CDC) at . The comments for ICD-10-PCS can be emailed to CMS at . Here is your opportunity to participate in the code development process! I look forward to seeing the results in June 2017.