Today I would like to call your attention to Type 2 myocardial infarction (MI), A21.A1, versus demand ischemia, I24.89. I frequently see denials associated with these two diagnosis codes due to conflicting documentation.
There is an Index entry under “Ischemia, demand, with myocardial infarction,” which is assigned to A21.A1. If the documentation is conflicting, you will need to query the provider regarding the establishment of the myocardial infarction.
The confirmation of the MI changes the code from I24.89 to I21.A1. Another reason to establish Type 2 MI is that demand ischemia is classified as a complication or comorbidity (CC) and Type 2 MI is a major CC (MCC). If you assign a single MCC to a case, then there is an increased likelihood that the case will be reviewed by a payer. This increased scrutiny is another reason to take the time and effort to clarify the presence of the MI.
The Coding Clinic for the fourth quarter of 2023, pgs. 78-79, reviews Chapter 9: Diseases of the Circulatory System updates to the guidelines. Type 2 myocardial infarction due to demand ischemia is assigned A21.A1. If a Type 2 myocardial infarction is described as NSTEMI or STEMI, only assign
A21.A1. Codes A21.01 through A21.4 are only to be assigned to Type 1 acute myocardial infarctions.
Do not confuse demand ischemia with non-ischemic myocardial injury, which is assigned I5A. This diagnosis is a myocardial injury in the absence of ischemia. Physicians utilize high-sensitivity troponin tests to distinguish whether the patient has suffered a non-ischemic myocardial injury versus one of the other myocardial infarction subtypes, according to the Coding Clinic for the fourth quarter of 2021, pgs. 14-15.
A good reference for the acute myocardial infarction subtypes is the Coding Clinic for the fourth quarter of 2017, pgs. 12-14. The acute myocardial infarction codes are found in category I21, with subsequent myocardial infarction codes in category I22.
When in doubt, query! It is much better to establish the diagnosis than to receive a clinical validation denial.
“Quality rankings” are often oxymoronic. My local paper recently had a headline asking “Does your clinic measure up? Check Minnesota’s quality rankings.” The paper proceeded to report
This week I want to follow up on two viruses I didn’t cover in my last article. The first is H5N1, also known as bird
Please log in to your account to comment on this article.
Uncover critical guidance. Kay Piper provides an interactive review on coding guidelines and more in the AHA’s second quarter 2025 ICD-10-CM/PCS Coding Clinic in an easy to access on-demand webcast.
Uncover critical guidance on the ICD-10-CM/PCS code updates effective with discharges and dates of service on or after 4/1/2025. Kay Piper reviews and updates coders on Obesity, COVID-19, and ICD-10-PCS coding guidelines in the AHA’s first quarter 2025 ICD-10-CM/PCS Coding Clinic in an easy to access on-demand webcast.
Physician queries are essential for accurate documentation and claims data, but they are increasingly scrutinized by payors, leading to denials and revenue leakage. This webcast, led by industry expert Cheryl Ericson, RN, MS, CCDS, CDIP, provides actionable strategies to craft compliant queries, reduce denials, and enhance revenue integrity. Attendees will gain insights into clinical validation queries, how to avoid common pitfalls, and learn best practices to defend against query denials. Don’t miss this opportunity to refine your query process and protect your organization’s financial health.
Master the complexities of heart failure coding with this expert-led webcast by Emily Montemayor, CCS, CMBCS, COC, CPC, CPMA. Discover strategies to ensure compliance with ICD-10-CM guidelines, documentation integrity, and capture comorbidities like CKD and hypertension. Learn how to resolve coding challenges, improve documentation practices, and submit clean claims to minimize denials and safeguard your organization’s financial health. With practical insights and real-world examples, this session equips you to prevent revenue leakage, enhance compliance, and secure optimal reimbursement—all while supporting better patient outcomes.
Providers face increasing Medicare audits when using skin substitute grafts, leaving many unprepared for claim denials and financial liabilities. Join veteran healthcare attorney Andrew B. Wachler, Esq., in this essential webcast and master the Medicare audit process, learn best practices for compliant billing and documentation, and mitigate fraud and abuse risks. With actionable insights and a live Q&A session, you’ll gain the tools to defend your practice and ensure compliance in this rapidly evolving landscape.
Dr. Ronald Hirsch dives into the basics of Medicare for clinicians to be successful as utilization review professionals. He’ll break down what Medicare does and doesn’t pay for, what services it provides and how hospitals get paid for providing those services – including both inpatient and outpatient. Learn how claims are prepared and how much patients must pay for their care. By attending our webcast, you will gain a new understanding of these issues and be better equipped to talk to patients, to their medical staff, and to their administrative team.
Hospitals face growing challenges in measuring observation metrics due to inconsistencies in classification, payer policies, and benchmarking practices. Join Tiffany Ferguson, LMSW, CMAC, ACM, and Anuja Mohla, DO, FACP, MBA, ACPA-C, CHCQM-PHYADV as they provide critical insights into refining observation metrics. This webcast will address key issues affecting observation data integrity and offer strategies for improving consistency in reporting. You will learn how to define meaningful metrics, clarify commonly misinterpreted terms, and apply best practices for benchmarking, and gain actionable strategies to enhance observation data reliability, mitigate financial risk, and drive better decision-making.
The 2025 Medicare Physician Fee Schedule brings significant changes to payment rates, coverage, and coding for physician services, impacting practices nationwide. Join Stanley Nachimson, MS., as he provides a comprehensive guide to understanding these updates, offering actionable insights on new Medicare-covered services, revised coding rules, and payment policies effective January 1. Learn how to adapt your practices to maintain compliance, maximize reimbursement, and plan for revenue in 2025. Whether you’re a physician, coder, or financial staff member, this session equips you with the tools to navigate Medicare’s evolving requirements confidently and efficiently.
Copyright © 2025 RACmonitor. Powered by MedLearn Media.
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
