MI Scenario Answers 2/13/15

A 54-year-old female was treated for an acute non-ST anterior wall MI. This patient also has atrial fibrillation. After discharge home, the patient presented to the ED two weeks later and was diagnosed with an acute inferior wall MI. She is still being monitored following her initial heart attack two weeks earlier and continues to have atrial fibrillation. She was treated with a cardiac catheterization while in the hospital. Upon discharge, the patient is referred to home health. What diagnosis codes will be assigned?

I22.1: (how to locate): Infarct, infarction, myocardium (acute) *with stated duration of 4 weeks or less), subsequent (recurrent) (reinfarction), inferior (diaphragmatic) (inferolateral) (inferoposterior) (wall)

I21.4: (how to locate): Infarct, Infarction, myocardium, myocardial (acute) (with stated duration of 4 weeks or less), non-ST elevation (NSTEMI)

I48.91: (how to locate): Fibrillation, atrial or auricular (established)

Rationale: The official coding guidelines specifically address the sequencing of I22 and I21 and this is stated as: “The sequencing of the I22 and I21 codes depends on the circumstances of the encounter.”

Pneumonia Scenario:

An elderly nursing home patient was seen for pneumonia. The patient has frequent aspiration pneumonia because of his difficulty in swallowing (neurogenic) due to a previous cerebral infarction. In addition to the aspiration type pneumonia, the patient also has stage I decubitus ulcers on both his left and right hip.  Code this scenario using the ICD-10-CM code set.

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