Within Medicaid Services (CMS) has increased the amount

Within recent years, the Centers for Medicare & Medicaid
Services (CMS) has increased the amount of detail required for proper hospice
coding. This increased level of detail is required for reporting not only the
direct reason a patient was put into hospice care, but also any comorbidities
not directly related to the patient’s terminal condition. Although this is all
useful information, these complex situations can easily trip up coders.

As part of a prerecorded event with AudioEducator, hospice
coding expert Judy
Adams reviews new
hospice codes for 2018, as well as complex real-life situations where a
patient may not have a clear diagnosis as the primary reason for being admitted
into hospice care. Adams also reviews the new ICD-10-CM codes for 2018,
including those related to heart conditions.

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Distinguishing Between Types of Myocardial Infarctions

For 2018, a key
subset of new and revised ICD-10-CM codes are those related to acute myocardial
infarctions (AMI or MI). Although there are six types of AMIs, the two most
frequently discussed are Type 1 and Type 2.

When it comes to submitting claims, it’s crucial to be able
to distinguish which type of AMI occurred. Put simply, a Type 1 AMI is a
spontaneous AMI related to ischemia (inadequate blood supply). This AMI would
have occurred because of a primary coronary event such as thrombotic occlusion
or plaque rupture. In contrast, a Type 2 AMI is secondary to ischemia and
occurs because of a mismatch in the supply and demand of the myocardial oxygen

2018 Changes to AMI Codes

codes this year focus heavily on Type 1 AMIs – namely, if what occurred was an
ST elevation myocardial infarction Type 1 (STEMI) or a Type 1 Non ST elevation
myocardial infarction (NSTEMI). A STEMI will typically be more of a “classic”
heart attack with significant blockage in an artery, whereas an NSTEMI will
present minor blockage in a major artery or full blockage in a minor artery.
For coding purposes, a STEMI would go under subcategories I21.0-I21.3, whereas
NSTEMIs would be coded as I21.4. If the report does not state the site of
disruption (anterior, inferior, lateral or true posterior wall), then code
I21.9 would be used. I21.9 is a new code now to be used with AMIs with
unspecified site or type.

Sometimes you’ll
find that a STEMI turns into an NSTEMI, or vice versa, which can be tricky for
coding. It’s not as complicated as it seems, however – just remember that
STEMIs take precedence. If a Type 1 NSTEMI turns into a STEMI, you would code
for a STEMI; if, however, a STEMI converts to an NSTEMI, you would still code
for a STEMI.

Additional I21 Codes

Type 1 AMIs do
receive the majority of attention this year in regards to coding, but we can’t
forget about Type 2. For this type of AMIs, you would code I21.A1, followed by
the underlying cause – if such a code is known and applicable. These underlying
causes include, but are not limited to:




obstructive pulmonary disease (COPD)


When coding for Type
2 AMIs, just remember that you should only assign code I21.A1 – it’s not
appropriate to use code I24.8 (other forms of ischemic heart disease).

If the AMI suffered
was of type 3, 4a, 4b, 4c or 5, use code I21.A9 according to the 2018
guidelines. Be sure to code any complications as well – such as stent
occlusions, stent stenosis, stent thrombosis or occlusion of coronary artery
bypass graft.

Finalizing Successful Claims

As a coder, you’ve got a lot on your plate, and CMS’s
requirements this year add even more. Hospice coding requirements are extensive
not just for MIs, but also for neoplasms, neurodevelopmental disorders, vision
loss, and nervous system syndromes. Continuous training is important to make
sure you always have the right and most updated information. Proper claims help
avoid rejected claims while keeping practices ticking along, which is why the
detailed presentation by Adams is an ideal reason to help ensure you’re always
right on track for whatever coding changes and challenges come your way.

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