Myocardial infarction, acute (AMI), subendocardial/non-transmural (non-Q-wave)
|Dx:||Myocardial infarction, acute (AMI), subendocardial/non-transmural (non-Q-wave)|
|Pre-ICD10 counterpart:||Myocardial infarction|
|Charlson/ALERT Scale:||Myocardial infarction|
|APACHE Como Component:||none|
|APACHE Acute Component:||Coronary Artery Disease|
|External ICD10 Documentation|
- In the acute ACS patient the term NSTEMI is generally used. Once the MI has evolved, it is a non-transmural infarct as evidenced by the absence of Q waves on the EKG.
- If the diagnosis of ACS is indicated by history and ECG, the diagnosis of NSTEMI may be established if a biomarker of myocardial injury has been released (i.e., troponin elevation). If there is no evidence of biochemical marker release suggestive of myocardial necrosis in a patient with suspected ACS, they may be considered to have experienced unstable angina.
MI - type vs mechanism
MIs are occasionally listed as "Type 2 MIs", ie no evidence of coronary artery disease (CAD). This refers to the mechanism, and the AMI codes include any/all mechanisms (including coronary artery embolism, thrombosis or thromboembolism); said another way, we don't particularly care about the mechanism. They should be coded based on their manifestation.
In ICD10, this will mean:
- Code the appropriate AMI code:
- Code the cause separately, as a Combined ICD10 codes. For example it might be one of the following:
- Coronary artery disease, chronic (atherosclerosis, chronic ischemic heart disease)
- Ischemic heart disease, acute NOS
- anemia - Category:Anemia
- hypovolemia - [[Dehydration (volume depletion, hypovolemia)]
MI - acute vs past history
To decide whether to code an acute MI dx in the Admit Diagnosis or Acquired Diagnosis / Complication, or a Past history, myocardial infarction (old MI) in the Comorbid Diagnosis, consider the following:
- Regarding an MI that occured prior to the current hospitalization -- might be coded as either Comorbid Diagnosis, or a Past history, myocardial infarction (old MI)
- In ICD10 the code for Past history, myocardial infarction (old MI) reads as follows: Healed myocardial infarction -- Past myocardial infarction diagnosed by ECG or other special investigation, but currently presenting no symptoms.
- If the prior MI is still active and we're not dealing with any current complications of it, then instead use one of the AMI codes, as a Comorbid Diagnosis.
- If the prior MI is still active and we are dealing with any current complications of it, then instead use one of the AMI codes, as a Admit Diagnosis.
- Examples: Papillary muscle rupture or Ongoing angina related to a recent MI prior to this unit/ward admission.
Alternate ICD10s to consider coding instead or in addition
Candidate Combined ICD10 codes
- Also code any acute complications, from list above.
Related CCI Codes
Data Integrity Checks (SMW)