ICD-10 Coding for Non-ST Elevation Myocardial Infarction(I21.4, I21.A1, I22.2)
Complete ICD-10-CM coding and documentation guide for Non-ST Elevation Myocardial Infarction. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Non-ST Elevation Myocardial Infarction
I21-I22Primary Range
Acute Myocardial Infarction
This range includes codes for acute myocardial infarction, including NSTEMI and STEMI.
I21.4Primary Range
Non-ST elevation (NSTEMI) myocardial infarction
Primary code for NSTEMI, indicating a subendocardial myocardial infarction.
Myocardial infarction type 2
Used for Type 2 MI, which is secondary to an imbalance in myocardial oxygen supply and demand.
Subsequent non-ST elevation (NSTEMI) myocardial infarction
Used for subsequent NSTEMI occurring within 28 days of a previous MI.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| I21.4 | Non-ST elevation (NSTEMI) myocardial infarction | Use when NSTEMI is explicitly documented with elevated troponin and no ST elevation on ECG. |
|
| I21.A1 | Myocardial infarction type 2 | Use when MI is secondary to another condition causing an imbalance in oxygen supply and demand. |
|
| I22.2 | Subsequent non-ST elevation (NSTEMI) myocardial infarction | Use for NSTEMI occurring within 28 days of a previous MI. |
|
Clinical Decision Support
Always review the patient's clinical documentation thoroughly. When in doubt, choose the more specific code and ensure documentation supports it.
Key Information: ICD-10 code for non-ST elevation myocardial infarction
Essential facts and insights about Non-ST Elevation Myocardial Infarction
Primary ICD-10-CM Codes for non street elevation myocardial infarction
Decision Criteria
clinical Criteria
- Elevated troponin and no ST elevation on ECG
documentation Criteria
- Explicit mention of NSTEMI
Applicable To
- Subendocardial myocardial infarction
- Non-transmural myocardial infarction
Excludes
- ST elevation myocardial infarction (STEMI)
Clinical Validation Requirements
- Elevated troponin levels
- Absence of ST elevation on ECG
Code-Specific Risks
- Misclassification if documentation does not specify NSTEMI.
Coding Notes
- Ensure explicit documentation of NSTEMI to avoid misclassification.
I21.A1 - Myocardial infarction type 2
Use when MI is secondary to another condition causing an imbalance in oxygen supply and demand.
Applicable To
- Demand ischemia
Excludes
- Type 1 NSTEMI
Clinical Validation Requirements
- Documentation of underlying cause
- Troponin elevation
Coding Notes
Ensure causal relationship is documented.
I22.2 - Subsequent non-ST elevation (NSTEMI) myocardial infarction
Use for NSTEMI occurring within 28 days of a previous MI.
Applicable To
- Recurrent NSTEMI within 28 days
Excludes
- Initial NSTEMI
Clinical Validation Requirements
- Documentation of prior MI within 28 days
- Elevated troponin levels
Coding Notes
Ensure correct sequencing with initial MI code.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Old myocardial infarction
I25.2Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Non-ST Elevation Myocardial Infarction to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code I21.4.
Impact
Clinical: Inaccurate treatment plans., Regulatory: Non-compliance with coding standards., Financial: Potential claim denials.
Mitigation Strategy
Educate clinicians on documentation requirements., Use templates to ensure completeness.
Impact
Reimbursement: Incorrect coding may lead to denied claims., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate clinical data representation.
Mitigation Strategy
Ensure documentation specifies Type 2 MI and underlying cause.
Impact
Reimbursement: Incorrect DRG assignment., Compliance: Violation of coding rules., Data Quality: Misleading patient history.
Mitigation Strategy
Always sequence I22.2 after the initial MI code.
Impact
Risk of coding NSTEMI when Type 2 MI is present.
Mitigation Strategy
Implement regular training and audits.
Documentation errors, coding pitfalls, and audit risks are interconnected aspects of medical coding and billing. Addressing all three areas helps ensure accurate coding, optimal reimbursement, and regulatory compliance.
Frequently Asked Questions
Common questions about ICD-10 coding for Non-ST Elevation Myocardial Infarction, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Non-ST Elevation Myocardial Infarction
Use these documentation templates to ensure complete and accurate documentation for Non-ST Elevation Myocardial Infarction. These templates include all required elements for proper coding and billing.
Emergency Department Admission for NSTEMI
Specialty: CardiologyRequired Elements
- Diagnosis of NSTEMI
- Troponin levels
- ECG findings
- Comorbid conditions
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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