Updated on: July 9, 2018

Type 2 Myocardial Infarction: Not a Fake Diagnosis

By
Original story posted on: July 6, 2018

  • Product Headline: Myocardial Infarction: Learn the Clinical Criteria and Guidelines to Avoid Denials
  • Product Image: Product Image
  • Product Description:
    WEBCAST AVAILABLE
    ON-DEMAND

ICD-10 code I21.A1 identifies Type 2 MI.

Over the past two months, I have been making the rounds speaking at regional and national conferences and going on-site for my consulting business. Many of you have approached me and assured me that the message I am trying to convey is indeed the message you are receiving.

I am not about the money – I am intent on getting providers to document accurately, specifically, and sufficiently to take excellent care of patients and to demonstrate how sick and complex they are. This optimizes quality metrics and reimbursement while preventing unwarranted hospital-acquired conditions (HACs) and patient safety indicators (PSIs). I never endorse exaggerating or upcoding. I believe I am actually quite conservative. I’d rather get it right up front than to have to fight a denial on the back end.

On June 20, I did a webinar on myocardial infarction (MI) – which, of course, included Type 2 myocardial infarctions. There has been some pushback from some individuals who decry the existence of this clinical entity and feel it is a “made-up diagnosis” that serves to jack up the DRG. They believe using it undermines the credibility of physician advisors and even have suggested that it harms patients.

Recently, our good friend Ron Hirsch (Ronald Hirsch, MD) brought to my attention an article in Circulation published online June 11, titled, “Type 2 Myocardial Infarction – Diagnosis, Prognosis, and Treatment,” by Cian McCarthy et. al. out of Massachusetts General Hospital and Brigham and Women’s Hospital. This article validated my viewpoint that Type 2 myocardial infarction is clinically relevant and important.

Their conclusion is this: “the diagnosis of Type 2 MI is associated with a poor prognosis: less than 40 percent of patients will live five years past their diagnosis.” They go on to explain that the poor prognosis is not surprising, because “Type 2 MI typically occurs among older patients with greater comorbidities and is identified in the context of hemodynamic instability.” The article goes on to note that “most deaths among patients with Type 2 MI are due to non-cardiovascular causes,” but that “approximately 30 percent of patients will have a cardiovascular event over five years,” which may even exceed that for patients with Type 1 MIs.

The article notes that there is precious little data and evidence-based guidelines regarding Type 2 MI. I am certain the fact that we didn’t have a way to separate out Type 2 MI from Type 1 MI in the ICD-10-CM code set strongly contributed to this shortfall. This was resolved in October 2017, when we got the unique code I21.A1 identifying Type 2 MI. We are now in a better position to be able to determine whether Type 2 MI demands its own treatment, or as has been the case in the past, you just treat the underlying condition. Insurance companies will have the ability to adapt their actuarial analyses, if needed.

I never recommend diagnosing and documenting conditions that are not present. I just want providers to practice excellent medicine and not to miss diagnosing and documenting conditions that are present. I say it harms patients if you don’t pick up the Type 2 MI, because it portends a worse prognosis. As Hippocrates would say, “primum non nocere” (first, do no harm).

 

Program Note:

Listen to Dr. Remer every Tuesday on Talk Ten Tuesday, 10 a.m. ET.

Erica E. Remer, MD, FACEP, CCDS

Erica Remer, MD, FACEP, CCDS has a unique perspective as a practicing emergency physician for 25 years, with extensive coding, CDI, and ICD-10 expertise. She was a physician advisor of a large multi-hospital system for four years before transitioning to independent consulting in July 2016. Her passion is educating CDI specialists, coders, and healthcare providers with engaging, case-based presentations on documentation, CDI, and denials management topics. She has written numerous articles and serves as the co-host of Talk Ten Tuesdays, a weekly national podcast. Dr. Remer is a member of the ICD10monitor editorial board, the ACDIS Advisory Board, and the board of directors of the American College of Physician Advisors.

Related Stories

  • Coding Quality: Obstacles and Solutions
    Developing a team approach can positively impact coding quality and reduce coding errors. Coding professionals are faced with a myriad of challenges that can significantly impede coding quality. Such challenges include ongoing, increasing pressure to meet management productivity standards and…
  • AHIMA: As Coding Evolves, So Must We
    A new white paper from the industry bellwether looks back, forward in framing big picture of coding. Benchmarking, the term that encompasses performance measurement in the healthcare industry, will be key for providers seeking to refine their efforts to master…
  • Polar Vortex Hastens Need for ICD-10 Cold Codes
    There are ICD-10 codes for cold weather injuries.The weather has been rough for the people living in the Midwest and Northeast. The reported temperatures have been as low as -60 with the wind chill factor applied. Such severity of temperatures…