Myocardial infarction, acute (AMI), subendocardial/non-transmural (non-Q-wave)

From CCMDB Wiki
Jump to navigationJump to search
ICD10 Diagnosis
Dx: Myocardial infarction, acute (AMI), subendocardial/non-transmural (non-Q-wave)
ICD10 code: I21.4
Pre-ICD10 counterpart: Myocardial infarction
Charlson/ALERT Scale: Myocardial infarction
APACHE Como Component: none
APACHE Acute Component: Coronary Artery Disease
External ICD10 Documentation
This diagnosis is a part of ICD10 collection.

Additional Info

  • 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:


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

Ischemic heart disease codes:
Myocardial Infarction codes:
Arterial thromboembolism codes:

Candidate Combined ICD10 codes

  • Also code any acute complications, from list above.

Related CCI Codes

Data Integrity Checks (SMW)

none found

Related Articles

Related articles:


Show all ICD10 Subcategories

ICD10 Categories: Abdominal trauma, Abortion, Acute intoxication, Addiction, Adrenal Insufficiency, Adverse effect, Alcohol related, Allergy, Anemia, Anesthetic related, Aneurysm, Antibiotic resistance, Antidepressant related, Aortic Aneurysm, Arrhythmia, Arterial thromboembolism, Asthma, Atherosclerosis, Awaiting/delayed transfer, Bacteria, Benign neoplasm, Breast disease, Burn, Cannabis related, Cardiac septum problem, Cardiovascular, Cerebral Hemorrhage/Stroke, Chemical burn, Chronic kidney disease, Cirrhosis, Cocaine related, Decubitus ulcer, Delirium, Dementia, Diabetes, Diagnosis implying death, Double duty pathogen, ENT, Encephalitis, Encephalopathy, Endocrine disorder, Endocrine neoplasm, Exposure, Eye, Female genital neoplasm, Fistula, Fracture, Fungus, GI ulcer, Gastroenteritis, Gastrointestinal, Gastrointestinal neoplasm, Hallucinogen related, Has one, Head trauma, Head trauma (old), Healthcare contact, Heart valve disease, Heme/immunology, Heme/immunology neoplasm, Hemophilia, Hemorrhage, Hepatitis, Hereditary/congenital, Hernia, Hypertension, Hypotension, Iatrogenic, Iatrogenic infection, Iatrogenic mechanism, Imaging, Infection requiring pathogen, Infection with implied pathogen, Infectious disease, Inflammatory Bowel Disease, Influenza, Inhalation, Intra-abdominal infection, Ischemia, Ischemic gut, Ischemic heart disease, Joint/ligament trauma, Leukemia, Liver disease, Liver failure, Lower limb trauma, Lower respiratory tract infection, Lymphoma, Male genital neoplasm, Mechanism, Meningitis, Metabolic/nutrition, Metastasis, Misc, Muscle problem, Muscles/tendon trauma, Musculoskeletal/soft tissue, Musculoskeletal/soft tissue neoplasm, Myocardial Infarction, Neck trauma... further results