Code for the Day: It's All About Heart (I21.-& I22.-)

I am not a fan of Valentines Day.  And please don't mistake this for bitterness, I just find it ridiculous that we have a holiday dedicated to telling the ones we love that we love them when there are 364 other perfectly good days in the year to confirm the sentiment.  So I really just see Valentines Day as an excuse for my grocery store to mark up the cost of roses for 2 weeks in February.  And let's be real here: I hate the combination of pink and red hearts.  I don't know what it is, but it makes me queasy.  Pink hearts alone are fine.  Red hearts alone are dandy.  But together, ick.  And it get even worse when they throw in those purple hearts for good measure.

As I sit here with my pink heart necklace - after all, I am a festive person and there are no red hearts in sight - I do like Valentines Day as a reminder of something more important: February is American Heart month.  Maybe you "go red" on Fridays or wear a red ribbon.  Maybe you take the month to become more educated on heart disease and the warning signs of a heart attack.  Today, I think we should definitely focus on ICD-10 coding for myocardial infarction!  So consider this my valentine to you: a short tutorial on what to expect in ICD-10 for coding myocardial infarction.

The first thing you need to know is that the definition of an acute myocardial infarction (AMI) has changed.  It is no longer one that has occurred within the past 8 weeks, the period is now reduced to 4.  You also no longer need to know if the AMI episode is the initial or a subsequent encounter for treatment.  In fact, forget everything you know about coding AMI in ICD-9-CM because it will just confuse you in ICD-10-CM.  Here are the highlights:

• The new period for an AMI is 4 weeks
• The terms ST elevation myocardial infarction (STEMI) and non-ST elevation myocardial infarction (NSTEMI) are now part of the code titles, not just inclusion terms for the codes
• AMI codes to two categories: 
• I21, ST elevation (STEMI) and non-ST elevation (NSTEMI) myocardial infarction
• I22, Subsequent ST elevation (STEMI) and non-ST elevation (NSTEMI) myocardial infarction
• Additional characters report the specific site of the AMI (heart wall or vessel)
• Sequencing depends on the circumstances of admission

The key to knowing when to use a code from category I21 versus one from category I22 is not when the patient receives treatment, but for which AMI he is receiving treatment for.  

Let's take an example.  Bob comes in February 14 with a heart attack.  This is so tragic for Bob's wife, who did not get her roses.  For this Valentines Day visit, we assign a code from category I21 for an initial AMI.  This is the first heart attack Bob has had in the last 4 weeks.  

Let's say Bob comes back on his anniversary, February 28 with a second heart attack. I'm really starting to feel sorry for Bob's wife.  Oh, and Bob too. For this second visit, we would assign a code from category I22 to show that this is a subsequent heart attack that occurred within the 4 week period of his initial heart attack.  You would assign a code from category I21 as a secondary diagnosis to report that first heart attack on Valentines Day.

As for sequencing, notice in Bob's case, I22 was put first on the second visit since it was the reason for his admission (after study, yada yada).  But what if Bob had been admitted for that first heart attack on the 14th and experienced his second while he was an inpatient?  In this case, the I21 would be sequenced first with I22 as a secondary.  Again, sequencing depends on the circumstances of admission.

I'll just let that sink in a bit.

Have a healthy and happy Valentines Day and enjoy the ones you love.  And if you must indulge, might I recommend some antioxidant chocolates and heart-healthy red wine?  Stay away from those overpriced roses!

Code for the Day: Let's Hope Steamboat Springs' Lighted Man Never Sees This on a Claim Form

I just spent a very fun weekend in Steamboat Springs with my boyfriend visiting his family.  For the second year in a row, we decided that the prime weekend for a visit was during Winter Carnival, which is pretty spectacular if you ever have the chance to witness it.  During the day, they load up Main Street with snow for events such as the donkey jump, where local cowboys saddle up their horses so they can drag kids on skis over ski jumps (something my boyfriend has experienced and survived) or the shovel race, where the cowboys drag "grown" men sitting on snow shovels down the street to see who can get the best time.

There are lots of other things going on as well.  Last year, we went to Howelsen Hill - home of the Steamboat Springs Winter Sports Club and training ground of many Olympians - to watch some ski jumps.  But perhaps the biggest draw is Saturday night's fireworks display and the Lighted Man.  This show begins after dark at Howelsen Hill as skiers carrying flares make their way down the mountain.  Cut your eyes to the right, and you will see ski jumpers with flares jumping through a ring of fire.  But the grand finale is always the Lighted Man - a skier outfitted in a suit of LED lights making his way down the hill while fireworks shooting from his body.

As for me, since I don't downhill ski, I spent the weekend running barefoot through snow-lined walkways from pool to pool at the hot springs, traipsing through a man-made ice castle, and giving cross country skiing a try. There were so many options for a code for the day, but I kept coming back to the Lighted Man.  Because codes on a claim tell a story, I just wonder what the insurance company would say should the Lighted Man have to report these codes:

• W39.xxxA, Discharge of firework, Initial encounter
• Y93.23, Activity, snow (alpine) (downhill) skiing, snow boarding, sledding, tobogganing and snow tubing

It's such a fun tradition, I hope he never has to find out. I didn't get close enough to the mountain this year to get a good pic of the Lighted Man, but if you'd like to see some great pictures of the Winter Carnival is like, there is a good synopsis if you click here.