EmailACS 0940 and Acute Myocardial Infarction
Publication Date: June 2006
ICD 10 AM Edition: Fourth edition
Retired Date: 30/6/2010
Query Number: 1892
ACS 0940 Ischaemic heart disease, section title Acute Myocardial Infarction (Classification) , pg 153. The 3rd paragraph of this section states “codes from category I21 should be assigned for an infarction in both the first hospital to which the patient is admitted for treatment and any other acute care facility to which the patient is transferred within 4 weeks (28 days) or less from onset of the infarction”. Coders are interpreting this standard differently.
Some interpret this to mean if a patient is treated for their AMI, discharged home then re-admitted to another hospital (or the same one) a few days later, the AMI should be coded during the subsequent episode if it is less than 28 days since the AMI first occurred. Other coders are only assigning an AMI code during a subsequent episode of care if the patient is admitted for an initial episode of care for an AMI and subsequently transferred to another hospital within 28 days of the initial AMI (usually for treatment). Basically coders are placing emphasis on two different things: 1) The 28 days or,2) The word “transferred”.
Question: If a patient has an AMI, is treated, discharged home (within 5 days), referred to another hospital for PTCA and stent insertion and subsequently admitted to that hospital 10 days after discharge from the first hospital, should the AMI be coded by the hospital performing the PTCA and stent insertion? If the MI is coded, the episode groups to DRG F10Z Percutaneous Coronary Angioplasty with AMI, WIES = 2.3343. If the MI is not coded (and coronary artery disease is assigned as the principal diagnosis), the episode groups to DRG F15Z Percutaneous Coronary Angioplasty without AMI with Stent Insertion, WIES 1.871.
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ACS 0940 Ischaemic Heart Disease pg 153
Some interpret this to mean if a patient is treated for their AMI, discharged home then re-admitted to another hospital (or the same one) a few days later, the AMI should be coded during the subsequent episode if it is less than 28 days since the AMI first occurred. Other coders are only assigning an AMI code during a subsequent episode of care if the patient is admitted for an initial episode of care for an AMI and subsequently transferred to another hospital within 28 days of the initial AMI (usually for treatment). Basically coders are placing emphasis on two different things: 1) The 28 days or,2) The word “transferred”.
Question: If a patient has an AMI, is treated, discharged home (within 5 days), referred to another hospital for PTCA and stent insertion and subsequently admitted to that hospital 10 days after discharge from the first hospital, should the AMI be coded by the hospital performing the PTCA and stent insertion? If the MI is coded, the episode groups to DRG F10Z Percutaneous Coronary Angioplasty with AMI, WIES = 2.3343. If the MI is not coded (and coronary artery disease is assigned as the principal diagnosis), the episode groups to DRG F15Z Percutaneous Coronary Angioplasty without AMI with Stent Insertion, WIES 1.871.
Search Details:
ACS 0940 Ischaemic Heart Disease pg 153
Response
The NCCH has been consulted with regards to this complex query, and has responded in the following manner:
'Due to the complexity of this issue, the NCCH is withholding a decision on this query in order to seek advice from the Cardiovascular CCCG and CSAC. A task has been created to investigate this matter further.
A final decision will be added to the query database when available.'
In light of this, the Committee has decided to provide an interim response that can be followed until the NCCH is in the position to provide a definitive position. When the NCCH does provide a response to this query, the VICC will ensure to highlight this in the ICD Coding Newsletter to ensure that Victorian coders are aware of this. In the meantime, Victorian coders should adhere to the following advice.
For patients who have previously had an AMI who are admitted or transferred to your hospital, apply ACS 0001 'Principal Diagnosis' and ACS 0002 'Additional Diagnoses' to determine if the AMI should be coded.
Once you have determined that the AMI requires coding,
· If the patient is admitted (or transferred) to your hospital within 28 days of the AMI, use the code for a current AMI
· If the patient is admitted (or transferred) to your hospital more than 28 days following the AMI, use the code for an 'old' AMI
Each case will depend on the individual circumstances.
We acknowledge that ACS 0940 'Ischaemic heart disease Acute Myocardial Infarction' refers to 'transferred' patients, however we consider that this should also apply to patients separated from hospital and readmitted.
'Due to the complexity of this issue, the NCCH is withholding a decision on this query in order to seek advice from the Cardiovascular CCCG and CSAC. A task has been created to investigate this matter further.
A final decision will be added to the query database when available.'
In light of this, the Committee has decided to provide an interim response that can be followed until the NCCH is in the position to provide a definitive position. When the NCCH does provide a response to this query, the VICC will ensure to highlight this in the ICD Coding Newsletter to ensure that Victorian coders are aware of this. In the meantime, Victorian coders should adhere to the following advice.
For patients who have previously had an AMI who are admitted or transferred to your hospital, apply ACS 0001 'Principal Diagnosis' and ACS 0002 'Additional Diagnoses' to determine if the AMI should be coded.
Once you have determined that the AMI requires coding,
· If the patient is admitted (or transferred) to your hospital within 28 days of the AMI, use the code for a current AMI
· If the patient is admitted (or transferred) to your hospital more than 28 days following the AMI, use the code for an 'old' AMI
Each case will depend on the individual circumstances.
We acknowledge that ACS 0940 'Ischaemic heart disease Acute Myocardial Infarction' refers to 'transferred' patients, however we consider that this should also apply to patients separated from hospital and readmitted.
