ICD-10 code I21.A1 identifies Type 2 MI.
Over the past two months, I have been making the rounds speaking at regional and national conferences and going on-site for my consulting business. Many of you have approached me and assured me that the message I am trying to convey is indeed the message you are receiving.
I am not about the money – I am intent on getting providers to document accurately, specifically, and sufficiently to take excellent care of patients and to demonstrate how sick and complex they are. This optimizes quality metrics and reimbursement while preventing unwarranted hospital-acquired conditions (HACs) and patient safety indicators (PSIs). I never endorse exaggerating or upcoding. I believe I am actually quite conservative. I’d rather get it right up front than to have to fight a denial on the back end.
On June 20, I did a webinar on myocardial infarction (MI) – which, of course, included Type 2 myocardial infarctions. There has been some pushback from some individuals who decry the existence of this clinical entity and feel it is a “made-up diagnosis” that serves to jack up the DRG. They believe using it undermines the credibility of physician advisors and even have suggested that it harms patients.
Recently, our good friend Ron Hirsch (Ronald Hirsch, MD) brought to my attention an article in Circulation published online June 11, titled, “Type 2 Myocardial Infarction – Diagnosis, Prognosis, and Treatment,” by Cian McCarthy et. al. out of Massachusetts General Hospital and Brigham and Women’s Hospital. This article validated my viewpoint that Type 2 myocardial infarction is clinically relevant and important.
Their conclusion is this: “the diagnosis of Type 2 MI is associated with a poor prognosis: less than 40 percent of patients will live five years past their diagnosis.” They go on to explain that the poor prognosis is not surprising, because “Type 2 MI typically occurs among older patients with greater comorbidities and is identified in the context of hemodynamic instability.” The article goes on to note that “most deaths among patients with Type 2 MI are due to non-cardiovascular causes,” but that “approximately 30 percent of patients will have a cardiovascular event over five years,” which may even exceed that for patients with Type 1 MIs.
The article notes that there is precious little data and evidence-based guidelines regarding Type 2 MI. I am certain the fact that we didn’t have a way to separate out Type 2 MI from Type 1 MI in the ICD-10-CM code set strongly contributed to this shortfall. This was resolved in October 2017, when we got the unique code I21.A1 identifying Type 2 MI. We are now in a better position to be able to determine whether Type 2 MI demands its own treatment, or as has been the case in the past, you just treat the underlying condition. Insurance companies will have the ability to adapt their actuarial analyses, if needed.
I never recommend diagnosing and documenting conditions that are not present. I just want providers to practice excellent medicine and not to miss diagnosing and documenting conditions that are present. I say it harms patients if you don’t pick up the Type 2 MI, because it portends a worse prognosis. As Hippocrates would say, “primum non nocere” (first, do no harm).
Program Note:
Listen to Dr. Remer every Tuesday on Talk Ten Tuesday, 10 a.m. ET.
EDITOR’S NOTE: In recognition of National Doctors’ Day, coming up at the end of the month, starting Monday, March 25, MedLearn Media will be honoring
Skyrocketing rates of improper payments have coincided with historically rapid enrollment in the MA program. It was a Centers for Medicare & Medicaid Services (CMS)
Please log in to your account to comment on this article.
Accurately determining the principal diagnosis is critical for compliant billing, appropriate reimbursement, and valid quality reporting — yet it remains one of the most subjective and error-prone areas in inpatient coding. In this expert-led session, Cheryl Ericson, RN, MS, CCDS, CDIP, demystifies the complexities of principal diagnosis assignment, bridging the gap between coding rules and clinical reality. Learn how to strengthen your organization’s coding accuracy, reduce denials, and ensure your documentation supports true medical necessity.
Denials continue to delay reimbursement, increase administrative burden, and threaten financial stability across healthcare organizations. This essential webcast tackles the root causes—rising payer scrutiny, fragmented workflows, inconsistent documentation, and underused analytics—and offers proven, data-driven strategies to prevent and overturn denials. Attendees will gain practical tools to strengthen documentation and coding accuracy, engage clinicians effectively, and leverage predictive analytics and AI to identify risks before they impact revenue. Through real-world case examples and actionable guidance, this session empowers coding, CDI, and revenue cycle professionals to shift from reactive appeals to proactive denial prevention and revenue protection.
Sepsis remains one of the most frequently denied and contested diagnoses, creating costly revenue loss and compliance risks. In this webcast, Angela Comfort, DBA, MBA, RHIA, CDIP, CCS, CCS-P, provides practical, real-world strategies to align documentation with coding guidelines, reconcile Sepsis-2 and Sepsis-3 definitions, and apply compliant queries. You’ll learn how to identify and address documentation gaps, strengthen provider engagement, and defend diagnoses against payer scrutiny—equipping you to protect reimbursement, improve SOI/ROM capture, and reduce audit vulnerability in this high-risk area.
Only ICD10monitor delivers what you need: updates on must-know changes associated with the FY26 IPPS, including new ICD-10-CM/PCS codes, CCs/MCCs, and MS-DRGs, plus insights, analysis and answers to your questions from two of the country’s most respected subject matter experts.
Get clear, practical answers to Medicare’s most confusing regulations. Join Dr. Ronald Hirsch as he breaks down real-world compliance challenges and shares guidance your team can apply right away.
Federal auditors are zeroing in on Inpatient Rehabilitation Facility (IRF) and hospital rehab unit services, with OIG and CERT audits leading to millions in penalties—often due to documentation and administrative errors, not quality of care. Join compliance expert Michael Calahan, PA, MBA, to learn the five clinical “pillars” of IRF-PPS admissions, key documentation requirements, and real-life case lessons to help protect your revenue.
During this essential RACmonitor webcast Michael Calahan, PA, MBA Certified Compliance Officer, will clarify the rules, dispel common misconceptions, and equip you with practical strategies to code, document, and bill high-risk split/shared, incident-to & critical care E/M services with confidence. Don’t let audit risks or revenue losses catch your organization off guard — learn exactly what federal auditors are looking for and how to ensure your documentation and reporting stand up to scrutiny.
Learn how to navigate the proposed elimination of the Inpatient-Only list. Gain strategies to assess admission status, avoid denials, protect compliance, and address impacts across Medicare and non-Medicare payors. Essential insights for hospitals.
Prepare for the 2025 CMS IPPS Final Rule with ICD10monitor’s IPPSPalooza! Click HERE to learn more
Get 15% OFF on all educational webcasts at ICD10monitor with code JULYFOURTH24 until July 4, 2024—start learning today!
CYBER WEEK IS HERE! Don’t miss your chance to get 20% off now until Dec. 1 with code CYBER25
CYBER WEEK IS HERE! Don’t miss your chance to get 20% off now until Dec. 2 with code CYBER24
