Frequently, Type 2 MI is inconsistently documented.
February is American Heart Month, a time to raise awareness of cardiovascular health and a time to shine a light on cardiac issues, especially myocardial infarction (MI).
Unfortunately, every year about 805,000 people in the United States have a heart attack. Basically, someone has a heart attack every 40 seconds.
One type of MI that you often hear about is Type 2 MI. Clinical documentation improvement (CDI) and coding experts at Innova Revenue Group decided that this would be a perfect time to discuss the associated documentation and coding challenges.
Type 2 MIs are a common pain point for CDI departments. This is due to conflicting or lack of clinical indicators in provider documentation that requires further clarification with a query.
Type 2 MIs are frequently incorrectly diagnosed and inconsistently documented. Per The Fourth Universal Definition of MI, released in 2018 by the Journal of the American College of Cardiology, a Type 2 MI is diagnosed in the presence of elevated troponins, primarily due to a supply/demand imbalance without coronary thrombosis (i.e. not due to CAD and the presence of at least one of the following):
A Type 2 MI results from an imbalance between myocardial oxygen supply and demand, unrelated to acute coronary artery thrombosis or plaque rupture. A Type 2 MI is a relative (as opposed to an absolute) deficiency in coronary artery blood flow, triggered by an abrupt increase in myocardial oxygen demand, a drop in myocardial blood supply, or both. In a Type 2 MI, myocardial injury occurs secondary to an underlying process and therefore requires correct documentation of the underlying cause as well.
Common examples of underlying causes of Type 2 MI include acute blood loss anemia (e.g. a GI bleed), acute hypoxia (e.g. COPD exacerbation), shock states (cardiogenic, hypovolemic, hemorrhagic, or septic), coronary vasospasm (e.g. spontaneous), and bradyarrhythmia. Patients with Type 2 MI often have a history of fixed obstructive coronary disease, which when coupled with the acute trigger facilitates the Type 2 MI; however, underlying CAD is not always present.
Type 2 non-ST elevation myocardial infarction (NSTEMI) is also a problematic term for coders. According to coding guidelines, when Type 2 NSTEMI is documented, the code for Type 2 MI should be assigned and the code for NSTEMI should be withheld. If a coder incorrectly assigns the code for a NSTEMI – I21.4 – the case will be inappropriately pulled into the National Cardiovascular Data Registry and included in the Centers for Medicare & Medicaid Services (CMS) cohort for 30-day readmission rates and 30-day mortality rates.
As you can see, getting the provider to properly diagnose a Type 2 MI is extremely important. The one thing to keep in mind is that in a Type 2 MI, there is always demand ischemia. If you see the provider documenting a Type 2 MI without demand ischemia, a query should be issued to validate clinically the diagnosis. If there is no ischemia, another possible diagnosis is myocardial injury. This diagnosis was introduced in The Fourth Universal Definition of MI, which is defined by at least one cardiac troponin concentration above the 99th percentile URL. In 2022, a new code, I5A (Non-ischemic myocardial injury (non-traumatic)) was introduced into the ICD-10-CM classification system. Similar to coding a Type 2 MI, myocardial injury requires the underlying cause to be sequenced first.
It is crucial for clinical documentation integrity specialists (CDISs) to educate providers on Type 2 MIs and the importance of documenting the underlying cause. This will reduce the number of queries sent and get claims out the door quicker!
Programming note: Listen to Lidiya Ter-Markarova report this story live today during Talk Ten Tuesdays with Chuck Buck and Dr. Erica Remer, 10 Eastern.
It’s no secret to any of us that there has been quite a bit of recent disagreement between the opposing sides of the political aisle
I’m going to skip over the topic of the hour with the government shutdown and address two actions the federal government has taken in the
Please log in to your account to comment on this article.
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.
This third session in our 2026 IPPS Masterclass will feature a review of FY26 changes to the MS-DRG methodology and new technology add-on payments (NTAPs), presented by nationally recognized ICD-10 coding expert Christine Geiger, MA, RHIA, CCS, CRC, with bonus insights and analysis from Dr. James Kennedy.
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.
RACmonitor is proud to welcome back Dr. Ronald Hirsch, one of his most requested webcasts. In this highly anticipated session, Dr. Hirsch will break down the complex Two Midnight Rule Medicare regulations, translating them into clear, actionable guidance. He’ll walk you through the basics of the rule, offer expert interpretation, and apply the rule to real-world clinical scenarios—so you leave with greater clarity, confidence, and the tools to ensure compliance.
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. 2 with code CYBER24
