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]] | 10200~~ | Yes | 1 |CC & Med | ~~Currently Collected~~ | | ||}}

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

{{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

*10203 - Myocardial Infarction - Lateral

*10204 - Myocardial Infarction - Inferior

*10205 - Myocardial Infarction - Posterior

*10206 - Myocardial Infarction - Right Ventricle

*10207 - Myocardial Infarction - Non Transmural (non Q)

*10208 - Myocardial Infarction - Intraoperative

*10209 - Myocardial Infarction - Postoperative

'''Item below not allowed in comorbid

*'''10210 - Myocardial Infarction aborted with TPA

| 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

**See [[ICU Var 2]] to ~~tag MI Care Map [[MAP]]~~.

== 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.

~~{{Discussion}}~~

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

~~== 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 shoudl 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 DXs? 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

~~==Data Integrity Rules==~~

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)

*If 102-10 you must not use any another 102 with a subcode.

*This rule is not yet implemented in ACCESS.

*See [[ICU Var 2]] to tag MI Care Map [[MAP]] {{discussion}}

** MAP isn't being checked anywhere because there is no cross-check if it is not true but just forgotten. If one should be made, we would need to actively track XMAP if someone is not getting MAP. Since we track [[BRR]] in the same field this would not be doable. Could move one of the two into the tmp fields. Maybe the bigger question is: should we collect this forever? Let's report on it, ask if they plan to do anything about it, and offer to collect again after. [[User:Ttenbergen|Ttenbergen]] 00:37, 5 May 2009 (CDT)

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

[[Category:ACS (old)]]

~~[[Category: Data Integrity Rules]]~~

~~[[Category: Questions Diagnosis~~]]

@@ Line 1: / Line 1: @@
-{{DX tag | Cardiovascular | [[:Category: Medical Problem | Medical Problem]]| [[:Category: Myocardial infarction | Myocardial infarction]] | Yes-see [[:Category: Myocardial infarction | Myocardial infarction]] | 10200 | Yes  | 1 |CC & Med | Currently Collected | | ||}}
+{{PreICD10 dx| NewDxArticle = Myocardial infarction, acute (AMI), NOS}}
+{{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
+*10203 - Myocardial Infarction - Lateral
+*10204 - Myocardial Infarction - Inferior
+*10205 - Myocardial Infarction - Posterior
+*10206 - Myocardial Infarction - Right Ventricle
+*10207 - Myocardial Infarction - Non Transmural (non Q)
+*10208 - Myocardial Infarction - Intraoperative
+*10209 - Myocardial Infarction - Postoperative
+'''Item below not allowed in comorbid
+*'''10210 - Myocardial Infarction aborted with TPA
+ | 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
-**See [[ICU Var 2]] to tag MI Care Map [[MAP]].
+== 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.
-{{Discussion}}
+For ICD 10 instructions for this, see [[Template:ICD10 Guideline MI type vs mechanism]]
-== 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 shoudl 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 DXs? 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
-==Data Integrity Rules==
+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)
-*If 102-10 you must not use any another 102 with a subcode.
-*This rule is not yet implemented in ACCESS.
-*See [[ICU Var 2]] to tag MI Care Map [[MAP]] {{discussion}}
-** MAP isn't being checked anywhere because there is no cross-check if it is not true but just forgotten. If one should be made, we would need to actively track XMAP if someone is not getting MAP. Since we track [[BRR]] in the same field this would not be doable. Could move one of the two into the tmp fields. Maybe the bigger question is: should we collect this forever? Let's report on it, ask if they plan to do anything about it, and offer to collect again after. [[User:Ttenbergen|Ttenbergen]] 00:37, 5 May 2009 (CDT)
-[[Category: Myocardial infarction]]
+[[Category:ACS (old)]]
-[[Category: Data Integrity Rules]]
-[[Category: Questions Diagnosis]]