Acute Inferior wall MI questions

Per H&P:
Patient had a Acute inferior wall MI on 1/26/17. Possibility this is ST elevation MI due to recent stent thrombosis of Right cornary artery due to discontinuation of his ASA and plavix because of GI bleeding, Anemia due to recent GI bleed, HTN, CAD, hyperlipidemia, DM II.
Do I code old MI I25.10?
SOC in home health done 3/24/17. Please guide me in coding this patient. need codes for PA.

Thanks everyone,


  • edited May 2017
    If the patient is seen more than 4 weeks past the MI use 'old MI' - code I25.2
  • Would you code that as a primary dx? That is the reason the patient needs physical therapy.
  • I'm confused with this also. If a patients MI is greater than 4 weeks and
    continues to require care related to this....the guideline says to use
    "aftercare code" ...what would that be? otherwise use old MI 125.2....could
    this be used as primary? or should the ASHD be used as the reason they had
    the MI in the first place.
  • Janet,

    The active state of the MI should be coded as long as it continues to require care. I25.2 is only for “old or healed myocardial infarctions not requiring further care” (4 weeks or greater). There is a coding tip at I25.2 that states “Do not use this code for the patient who continues with symptoms after 4 weeks from an MI”.
  • edited May 2017
    Curious though if weakness and needing therapy post MI/ hospitalization is really what is meant by symptoms? I think I would use the CAD but I’m a new coder….
  • I put this question out to another post. Lisa Selman Holman responded that
    I use the CAD if documented...which it is. The MI was old so I wouldn't use
    the I25.2
  • Hello,

    I’m getting in too much of a hurry. Sorry!

    I meant to say that the active state of the MI should be coded for up to 4 weeks, then the “aftercare” will replace it at that point if the patient continues to experience related symptoms. Disease processes that led to the MI (specifically CAD) that still exists should still be coded as well.

    With that being said, I do not know what the specific “aftercare code” is for s/p MI. Good question!
  • Yes!

    I’m sorry. I meant to say “up to 4 weeks” as you had. I sent another reply that hasn’t come through yet. However, I still don’t know what the “aftercare of MI” would be.
  • In Chapter 9, Diseases of the Circulatory System, I noted that I25.5 Ischemic Cardiomyopathy has a Coding Tip that makes sense to me in this situation being discussed: “Ischemic Cardiomyopathy includes a patient with an MI older than 4 weeks when still presenting with symptoms. If a patient is being recertified after being admitted after an acute MI, use this code instead of an acute MI code.”

    Nancy Wolverton RN, CCM, HCS-D-10
    Utilization Review Specialist
    Kindred at Home
    Little Rock, Arkansas
    501-508-8526 (o)
    501-690-2027 (c)
  • Hi Nancy,
    I don't see any coding tip with I25.5?? What book are you using? What am I
  • I am using the 2016 Decision Health ICD-10 Coding Manual
    I am not currently coding and stopped using the DH Coding Center last summer.
    Forgive me if my info is out of date but the medical situation is well defined with this code.
    Just my humble opinion and out-dated reference book.

    Nancy Wolverton RN, CCM, HCS-D-10
    Utilization Review Specialist
    Kindred at Home
    Little Rock, Arkansas
    501-508-8526 (o)
    501-690-2027 (c)
  • edited May 2017
    Found this in a featured article attached to I25.2 in the coding center...

    Know how to apply puzzling guideline
    Include the aftercare code Z51.89 (Encounter for other specified aftercare) to capture continued care for a patient’s symptoms following an MI that is more than four weeks old, according to Q4 2012 Coding Clinic guidance.

    The Coding Clinic guidance points to the official coding guidelines, which instruct the coder to assign “the appropriate aftercare code” for a patient still receiving care for an MI more than four weeks old. [I.C.9.e.1]

    However, this guidance is a source of consternation for both coders who aren’t used to coding aftercare for MIs and who don’t feel that the vague Z51.89 adequately paints the picture of the patient’s condition and care.

    “We’ve never had an aftercare code for medical condition before,” Adams says.

    The guidance makes little sense and needs further inquiry as it does not provide a way to show that the patient had a heart attack, agrees Lisa Selman-Holman, HCS-D, principal of Selman-Holman and Associates and the coding service CoDR — Coding Done Right in Denton, Texas.

    But in the interim, Selman-Holman recommends coding CAD with angina (I25.11-), if the diagnosis can be verified, along with the Z51.89 code.

    For a patient still having symptoms from an old MI who doesn’t have atherosclerotic heart disease, attempt to determine what the underlying cardiac diagnosis is and assign that with the aftercare code, Adams says.

    If such a diagnosis can’t be determined, assign codes that capture the symptoms the patient continues to have, such as R07.9 (Chest pain, unspecified) and R06.00 (Dyspnea, unspecified), she says.
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