ACS

For the purposes of this article, ACS is a catch-all term for cardiac symptoms that may or may not include an MI. Doctors use the term in the charts, making it difficult for data collectors to know which dx to use.

• 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. Ttenbergen 18:39, 2012 September 6 (CDT)

Discussion

Coding

• Should ACS be added to the diagnosis list? If so, how will that affect the following codes:
  • Unstable angina (151-00)
  • Acute coronary insufficiency (152-00)
  • nontransmural MI (102-07)
• How do we want to code this for our database?
• Is this a patient care concern?

Is it a patient care concern if Docs call an MI ACS?

• 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?TAngell 09:42, 17 June 2008 (CDT)
  • 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)

Attempt at fix

• 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.
  • 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) JWinestock 17:06, 3 March 2009 (CST)
    • We need to form a workgroup and have folks work on this one.

A. what is types of cardiac problems are grouped under "ACS syndrome".

B. What is the new definition going to be.

C. How to remap then convert the previous codes into current ACS code. The programmer would have to write a conversion.

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.TOstryzniuk 23:18, 11 March 2009 (CDT)

• • • • 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.--FLindell 09:34, 16 April 2009 (CDT)

• 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.--LKolesar 13:20, 14 April 2009 (CDT)
• 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.

Supply-Demand mismatch

• More and more doctors are charting pt has a supply-demand mismatch.
  • 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?
  • 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?
  • 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
    • Shirley these are all very good questions why don't you add it to the agenda for the staff meeting?GHall 18:56, 21 February 2010 (CST)
• Hi all, I am wondering if this is a case where reviewing the General Diagnosis Coding Guidelines would clarify. Could you have a look? Ttenbergen 10:40, 24 February 2010 (CST)