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| For the purposes of this article, [http://en.wikipedia.org/wiki/Acute_coronary_syndrome ACS] is a catch-all term for cardiac symptoms that may or may not include an [[Myocardial infarction|MI]]. Doctors use the term in the charts, making it difficult for data collectors to know which dx to use. (ACS is not a "catch-all" term for cardiac symptoms, it is a syndrome which is caused by coronary artery disease that can present as angina, EKG changes, cardiac enzyme elevation, etc. ) There are many "cardiac symptoms" that would not be considered ACS ie CHF symptoms may be part of ACS but it may not be. --[[User:LKolesar|LKolesar]] 15:45, 2014 September 5 (CDT)
| | When a Data Collector see only an '''ACS''' (acute coronary syndrome) diagnosis on a chart, then they should seek information to code one or more of the following: |
| | *[[Myocardial infarction]] (10200) |
| | *[[Unstable angina]] (15100) |
| | *[[Acute coronary insufficiency ]] (15200) |
| | *[[Witnessed Cardiac Arrest]] (10002) or [[Unwitnessed Cardiac Arrest]] (10001) |
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| {{Discussion}}
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| * is this still a problem? If so it might be something to ask Dr Roberts to address with his physicians. If this is an inappropriate dx often used by them then that would be the place to address it. [[User:Ttenbergen|Ttenbergen]] 18:39, 2012 September 6 (CDT)
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| **The term ACS has virtually replaced the term angina in the clinical setting (and it is appropriate), much like the term nonstemi has replaced the term nonQ MI. We still know to code non stemis as nonQ mi because some of our terms have not been updated in the list of diagnoses. Based on the discussion below I get the sense that most collectors are using appropriate codes as a substitute for the more commonly used ACS. [[User:Jthiessen|Jthiessen]] 10:47, 2014 September 5 (CDT)
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| *** I have flagged this for the next ICU task group meeting. Ttenbergen 13:34, 2014 September 5 (CDT)
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| *** Another code that we could also discuss is type 2 MI which is an MI not caused by Coronary Artery Disease but instead by reduced oxygen supply or increased oxygen demand for other reasons. For example a pt who is severely anemic could suffer an MI even with normal coronary arteries. ACS has been used for at least 10 years already and is a well established diagnosis. It just means that the patient has coronary artery compromise which results in angina which may or may not lead to a myocardial infarction. This is not all that complicated. I would like to be part of the discussion on any change in the code structure. Of course this may open a large can of worms because there are other updated changes in terminology that we should then look at renewing in the database. There are also many conditions, procedures and surgeries that we do not even have codes for but this is another discussion. I think once we go to ICD 10 this may get resolved on all counts. --[[User:LKolesar|LKolesar]] 15:34, 2014 September 5 (CDT)
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| == Discussion ==
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| === Coding ===
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| * Should ACS be added to the diagnosis list? If so, how will that affect the following codes:
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| ** [[Unstable angina]] (151-00)
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| ** [[Acute coronary insufficiency ]] (152-00)
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| ** [[Myocardial infarction | nontransmural MI]] (102-07)
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| * How do we want to code this for our database?
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| * Is this a patient care concern?
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| === Is it a patient care concern if Docs call an MI ACS? ===
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| * It is my understanding that if there is diagnosis of MI then the nurse can initiate the MI care map without a doctors order, or at least alert the nurse enough to ask for the MI care map. The MI care map is best practice in the region. If the ACS is used as a diagnosis and the MI care map is not done could this not impact negatively on patient care and outcomes? I have notice a trend in not using the MI care map at my hospital. Also could this not impact negatively on resources that would be available on the wards/service in the future?[[User:TAngell|TAngell]] 09:42, 17 June 2008 (CDT)
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| ** I agree with Tara more and more infarcts are being missed here and at HSC they are just coding ACS. So we will have to check Mibbi results TNIs (how High?) EKG and asking the physicians was this an infarct? (SKiesman 15:01, 23 June 2008)
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| ===Attempt at fix===
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| *At our most recent meeting on April 8,2009 Trish said if the doctors are calling the cardiac chest pain "unstable angina" code it that way. If they are calling the cardiac chest pain coronary insufficiency then code it that way.She mentioned taking away the definitions in the code book.
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| **I agree with you that the wording or classifications are used differently now. At the VIC if it is not clearly an STEMI or a NSTEMI we use Acute Coronary Insufficiency. If they have a history of chest pain that is not described as Unstable angina, we use 152 - Chronic stable angina. I would like us to be to use the classification ACS (unless it is clearly an NSTEMI) [[User:JWinestock|JWinestock]] 17:06, 3 March 2009 (CST)
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| ***We need to form a workgroup and have folks work on this one.
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| ::::A. what is types of cardiac problems are grouped under "ACS syndrome".
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| ::::B. What is the new definition going to be.
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| ::::C. How to remap then convert the previous codes into current ACS code. The programmer would have to write a conversion.
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| ::::Volunteers for this working group or I will choose? One of the collectors from STB should be on it since the "BIG Cardiology" team is there now.[[User:TOstryzniuk|TOstryzniuk]] 23:18, 11 March 2009 (CDT)
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| ****Without doctor's input from the very beginning, this will turn out to be ineffecient use of our time. So my suggestion is first get a cardiologist to volunteer to be on this panel, then ask data collectors who are interested to volunteer. Therefore the final decision will be sanctioned and supported by the doctors.--[[User:FLindell|FLindell]] 09:34, 16 April 2009 (CDT)
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| {{Discussion}}
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| * The term coronary insufficiency is rarely used and usually once the patient is in the unit for a few hours they know whether an infarct has occured or not. Unstable angina is used if the diagnosis is Acute Coronary Syndrome(ACS) and there is no evidence of infarct, only ischemia. If an MI is evident, it is either NSTEMI or STEMI, depending on the 12 lead evidence and enzymes. I think we should check with a cardiologist to see if the term coronary insufficiency has value in our program any more since the new terminology took effect. By the way ACS is the correct terminology for many years already.--[[User:LKolesar|LKolesar]] 13:20, 14 April 2009 (CDT)
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| * At our most recent meeting on April 8,2009 Trish said if the doctors are calling the cardiac chest pain "unstable angina" code it that way. If they are calling the cardiac chest pain coronary insufficiency then code it that way.She mentioned taking away the definitions in the code book.
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| === Supply-Demand mismatch ===
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| *More and more doctors are charting pt has a supply-demand mismatch.
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| **Case 1. I had a patient come in iatrogenic hyperthyroidism causing a new at fib ,high blood pressure, and abd pain .CPK 586 TNT 1.4 the doctors stated no infarct I coded as coronary insufficiency Is this right or wrong?
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| **Case 2 Drs notes sepsis /supply demand mismatch Pt has chest pain EKG has ant lat changes ischemia TNT 0.42 DX. pneumonia I coded as nonq infarct drs coded as supply/demand mismatch no mention of MI did I code wrong?
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| **Case 3 When a pt comes back from an angio and needs immediate surgery for 3 vessel disease and has no pain post angio now you have already code an infarct or angina as an admit How do you code the blockage ?as ? coronary insufficiency. How does everyone code ISHD as a comorb? One more question how do you code "heart strain supply demand mismatch" positive TNT no chest pain no ekg changes due to severe low hemoglobin is this coronary insufficiency? the reason the hemoglobin was low is already coded . Thanks Shirley
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| *Hi all, I am wondering if this is a case where reviewing the [[General Diagnosis Coding Guidelines]] would clarify. Could you have a look? [[User:Ttenbergen|Ttenbergen]] 10:40, 24 February 2010 (CST)
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| [[Category: Diagnosis Coding]] | | [[Category: Diagnosis Coding]] |
| [[Category: Diagnosis not coded]] | | [[Category: Diagnosis not coded]] |