Myocardial infarction: Difference between revisions

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{{DX tag | Cardiovascular | ~~[[:Category:~~ Medical Problem | ~~Medical Problem]]| [[:Category:~~ Myocardial infarction | ~~Myocardial infarction]] | Yes-see [[:Category: Myocardial infarction~~ | Myocardial infarction]] |

{{PreICD10 dx| NewDxArticle = Myocardial infarction, acute (AMI), NOS}}

10200 - Myocardial Infarction

{{PreICD10 dx| NewDxArticle = Myocardial infarction (STEMI), acute (AMI), transmural (Q-wave)}}

{{PreICD10 dx| NewDxArticle = Myocardial infarction (NSTEMI), acute (AMI), subendocardial/non-transmural (non-Q-wave)}}

{{DX tag | Cardiovascular Problems | Medical Problem| Myocardial infarction | | Myocardial infarction |

*10200 - Myocardial Infarction

*10201 - Myocardial Infarction - Anterior

*10201 - Myocardial Infarction - Anteroseptal

Line 12:

Line 16:

'''Item below not allowed in comorbid

*'''10210 - Myocardial Infarction aborted with TPA

| Yes | 1 |CC & Med | ~~Currently Collected~~ | | ||}}

| Yes | 1 |CC & Med | | | ||}}

In CCI/ICD10 this will be coded by coding the MI as an ICD10 dx, and then [[Pharmacotherapy, thrombolytic agent]] with the [[CCI component 1 codes - what organ was something done to]].

== Criteria==

*Documented CPK rise or classic EKG changes

==~~Proposed coding of type 2~~ MI==

== MI Coding instructions ==

MIs are occasionally listed as "Type 2 MIs", ie no evidence of coronary artery disease(CAD). This refers to the mechanism, and we don't care about the mechanism. They should be coded based on their manifestation.

For ICD 10 instructions for this, see [[Template:ICD10 Guideline MI type vs mechanism]]

In the old coding schema, this means:

* ++discussion++ I have no idea what it means in the old schema; I just needed to break out Allan's answer. Chances are similar things apply in the old schema. Leaving the discussion trail in here for now for this.

*I have seen quite a few type 2 MI's and our database really does not deal with this. A type 2 MI is when there is no evidence of coronary artery disease, but the MI still occurs for other reasons. It occurs when there is supply/demand mismatch with no CAD. The most common one we see is related to prolonged anemia where the pt's oxygen-carrying capacity is reduced. Another reason would be reduced blood volume (hypovolemia), profound bradycardia, etc. These conditions can cause an MI even with normal coronary arteries.

* I propose that if there is a supply/demand mismatch with normal coronaries and there is an elevated troponin, we call in a non Q MI (NSTEMI)unless there is a clear diagnosis of a STEMI or other reason for an increased troponin. The other option is to make a new category for type 2 MI.--[[User:LKolesar|LKolesar]] 14:38, 2015 November 16 (CST)

* I don't think this is new...we recognize this in the ACS population...if angio isn't done coronary arteries/status would not be known but we still code as NSTEMI(reviewing the EKGs and cardiology consult notes) and have been for awhile.--[[User:Llemoine|Llemoine]] 14:47, 2015 November 16 (CST)

* I don't think this is new...we recognize this in the ACS population...if angio isn't done coronary arteries/status would not be known but we still code as NSTEMI (reviewing the EKGs and cardiology consult notes) and have been for awhile.--[[User:Llemoine|Llemoine]] 14:47, 2015 November 16 (CST)

~~== Discussion - elimination of subcodes ==~~

~~{{discussion}}~~

*I would like to move away from using any of the subcodes for MI's in COMORBID coding, just allow 10200 if pt had an MI in past prior to hosp admission. Thought it is nice to have there is no value added to comorbid calculation, and also coding is not consistent because chart notes frequently don't indicate the location of the heart where MI had occurred in the past. --[[User:TOstryzniuk|TOstryzniuk]] 17:48, 23 December 2010 (CST)

** If you want I can make the subcodes unavailable as comos; just say the word. Ttenbergen 17:45, 2012 October 31 (EDT) {{Potential Change}}

~~== Discussion - subdxs not mutually exclusive ==~~

~~{{discussion}}~~

* The subdiagnoses are not mutually exclusive, an MI could be both post-op and anterior. What is the precedence with which to collect these? Even if we explain this here, there still is a risk of misunderstanding. I think the ones that are not exclusive should be eliminated. (The same is probably true for other dxs) [[User:Ttenbergen|Ttenbergen]] 12:51, 18 February 2009 (CST)

** On second thought, would we just code both post-op and anterior, leading to two MI dxs? If so, which goes first, since we report on [[Primary Admit Diagnosis]]? Also, does this lead to higher numbers of MI reported? If a patient in fact has two MIs, one post-op with location unknown, and one anterior when first admitted, would our db report this as just one MI or as several? I will send this to Julie as well.[[User:Ttenbergen|Ttenbergen]] 12:56, 18 February 2009 (CST)

***Good point Tina because we only list 6 dx, how do we priortize if the MI is both post-op and anterior if we do not have room on our dx list? Which is more NB to know, the MI being post-op or the location of the MI?--[[User:MWaschuk|MWaschuk]] 13:49, 18 February 2009 (CST)

*** I agree with you as well. Is the criteria for post-op defined by a time line e.g. 48 hours or less,or is there a definite criteria?--User:JKothuber

**** In past discussion with Trish, when I collected CCU here at HSC, Trish had indicated that only one Dx of MI should be captured, otherwise it indicates 2 episodes of MI. The post-op MI is of more significance because it indicates both MI and complication. --[[User:FLindell|FLindell]] 12:58, 5 November 2010 (CDT)

** I'll ping this old discussion to see if we can resolve. [[User:Ttenbergen|Ttenbergen]] 14:18, 2012 September 5 (CDT)

~~=={{CCMDB Data Integrity Checks}}==~~

*If 102-10 (MI Aborted with TPA) you must not use any another 102 with a subcode.

*This rule is not yet implemented in ACCESS.

** {{Discussion}} That's because this rule is not documented (or show me where). Pls document and address the above questions (since the answer could modify any such check) and then add to [[Requested Changes]]. Ttenbergen 01:45, 2012 November 2 (EDT)14:20, 2012 September 5 (CDT) 17:06, 4 November 2010 (CDT)

~~{{Potential Change}}~~

~~[[Category: Myocardial infarction]]~~

[[Category:ACS (old)]]

~~[[Category: Charlson Comorbid Diagnosis]]~~

~~[[Category: Charlson - Myocardial infarction]]~~

~~[[Category: Comorbid Diagnosis]]~~

[[Category: ACS]]

@@ Line 1: / Line 1: @@
-{{DX tag | Cardiovascular | [[:Category: Medical Problem | Medical Problem]]| [[:Category: Myocardial infarction | Myocardial infarction]] | Yes-see [[:Category: Myocardial infarction | Myocardial infarction]] |
+{{PreICD10 dx| NewDxArticle = Myocardial infarction, acute (AMI), NOS}}
-- Myocardial Infarction
+{{PreICD10 dx| NewDxArticle = Myocardial infarction (STEMI), acute (AMI), transmural (Q-wave)}}
+{{PreICD10 dx| NewDxArticle = Myocardial infarction (NSTEMI), acute (AMI), subendocardial/non-transmural (non-Q-wave)}}
+{{DX tag | Cardiovascular Problems | Medical Problem| Myocardial infarction |  | Myocardial infarction |
+*10200 - Myocardial Infarction
 *10201 - Myocardial Infarction - Anterior
 *10201 - Myocardial Infarction - Anteroseptal
@@ Line 12: / Line 16: @@
 '''Item below not allowed in comorbid
 *'''10210 - Myocardial Infarction aborted with TPA
-  | Yes  | 1 |CC & Med | Currently Collected | | ||}}
+  | Yes  | 1 |CC & Med |  | | ||}}
+In CCI/ICD10 this will be coded by coding the MI as an ICD10 dx, and then [[Pharmacotherapy, thrombolytic agent]] with the [[CCI component 1 codes - what organ was something done to]].
 == Criteria==
 *Documented CPK rise or classic EKG changes
-==Proposed coding of type 2 MI==
+== MI Coding instructions ==
+MIs are occasionally listed as "Type 2 MIs", ie no evidence of coronary artery disease(CAD). This refers to the mechanism, and we don't care about the mechanism. They should be coded based on their manifestation.
+For ICD 10 instructions for this, see [[Template:ICD10 Guideline MI type vs mechanism]]
+In the old coding schema, this means:
+* ++discussion++ I have no idea what it means in the old schema; I just needed to break out Allan's answer. Chances are similar things apply in the old schema. Leaving the discussion trail in here for now for this.
 *I have seen quite a few type 2 MI's and our database really does not deal with this.   A type 2 MI is when there is no evidence of coronary artery disease, but the MI still occurs for other reasons.  It occurs when there is  supply/demand mismatch with no CAD.   The most common one we see is related to prolonged anemia where the pt's oxygen-carrying capacity is reduced.  Another reason would be reduced blood volume (hypovolemia), profound bradycardia, etc.  These conditions can cause an MI even with normal coronary arteries.
 * I propose that if there is a supply/demand mismatch with normal coronaries and there is an elevated troponin, we call in a non Q MI (NSTEMI)unless there is a clear diagnosis of a STEMI or other reason for an increased troponin.  The other option is to make a new category for type 2 MI.--[[User:LKolesar|LKolesar]] 14:38, 2015 November 16 (CST)
-* I don't think this is new...we recognize this in the ACS population...if angio isn't done coronary arteries/status would not be known but we still code as NSTEMI(reviewing the EKGs and cardiology consult notes) and have been for awhile.--[[User:Llemoine|Llemoine]] 14:47, 2015 November 16 (CST)
+* I don't think this is new...we recognize this in the ACS population...if angio isn't done coronary arteries/status would not be known but we still code as NSTEMI (reviewing the EKGs and cardiology consult notes) and have been for awhile.--[[User:Llemoine|Llemoine]] 14:47, 2015 November 16 (CST)
-== Discussion - elimination of subcodes ==
-{{discussion}}
-*I would like to move away from using any of the subcodes for MI's in COMORBID coding, just allow 10200 if pt had an MI in past prior to hosp admission.  Thought it is nice to have there is no value added to comorbid calculation, and also coding is not consistent because chart  notes frequently don't indicate the location of the heart where MI had occurred in the past. --[[User:TOstryzniuk|TOstryzniuk]] 17:48, 23 December 2010 (CST)
-** If you want I can make the subcodes unavailable as comos; just say the word. Ttenbergen 17:45, 2012 October 31 (EDT) {{Potential Change}}
-== Discussion - subdxs not mutually exclusive ==
-{{discussion}}
-* The subdiagnoses are not mutually exclusive, an MI could be both post-op and anterior. What is the precedence with which to collect these? Even if we explain this here, there still is a risk of misunderstanding. I think the ones that are not exclusive should be eliminated. (The same is probably true for other dxs) [[User:Ttenbergen|Ttenbergen]] 12:51, 18 February 2009 (CST)
-** On second thought, would we just code both post-op and anterior, leading to two MI dxs? If so, which goes first, since we report on [[Primary Admit Diagnosis]]? Also, does this lead to higher numbers of MI reported? If a patient in fact has two MIs, one post-op with location unknown, and one anterior when first admitted, would our db report this as just one MI or as several? I will send this to Julie as well.[[User:Ttenbergen|Ttenbergen]] 12:56, 18 February 2009 (CST)
-***Good point Tina because we only list 6 dx, how do we priortize if the MI is both post-op and anterior if we do not have room on our dx list?  Which is more NB to know, the MI being post-op or the location of the MI?--[[User:MWaschuk|MWaschuk]] 13:49, 18 February 2009 (CST)
-*** I agree with you as well. Is the criteria for post-op defined by a time line e.g. 48 hours or less,or is there a definite criteria?--User:JKothuber
-**** In past discussion with Trish, when I collected CCU here at HSC, Trish had indicated that only one Dx of MI should be captured, otherwise it indicates 2 episodes of MI. The post-op MI is of more significance because it indicates both MI and complication. --[[User:FLindell|FLindell]] 12:58, 5 November 2010 (CDT)
-** I'll ping this old discussion to see if we can resolve. [[User:Ttenbergen|Ttenbergen]] 14:18, 2012 September 5 (CDT)
-=={{CCMDB Data Integrity Checks}}==
-*If 102-10 (MI Aborted with TPA) you must not use any another 102 with a subcode.
-*This rule is not yet implemented in ACCESS.
-** {{Discussion}} That's because this rule is not documented (or show me where). Pls document and address the above questions (since the answer could modify any such check) and then add to [[Requested Changes]]. Ttenbergen 01:45, 2012 November 2 (EDT)14:20, 2012 September 5 (CDT) 17:06, 4 November 2010 (CDT)
-{{Potential Change}}
-[[Category: Myocardial infarction]]
+[[Category:ACS (old)]]
-[[Category: Charlson Comorbid Diagnosis]]
-[[Category: Charlson - Myocardial infarction]]
-[[Category: Comorbid Diagnosis]]
-[[Category: ACS]]