Type II Myocardial Infection -- Be Sure to Always Code the Underlying Cause First!

As a reminder for us all, Type 2 myocardial infarction (MI) is defined by a rise and fall of cardiac biomarkers and evidence of ischemia without unstable coronary artery disease (CAD), due to a mismatch in myocardial oxygen supply and demand. Myocardial injury is similar but does not meet clinical criteria for MI. There is uncertainty regarding clinical characteristics, management and outcomes of type 2 MI and myocardial injury in comparison to type 1 MI. (Coron Artery Dis. 2018 Jan; 29(1): 46–52)

Basically, it helps to think of it this way: a type 2 MI is always a consequence of something unrelated to a clog in a coronary artery.

The important thing to remember: The Type II MI is always coded second, after the underlying cause.

“In the setting of a type II Myocardial Infarction, underlying etiology should be coded first, followed by the type 2 MI code.”

I21.A1 Myocardial Infarction Type 2

Code First

• the underlying cause, such as:

- anemia D50.0 D64.9

- chronic obstructive pulmonary disease J44

- paroxysmal tachycardia I47.0 I47.9

- shock R57.0 R57.9

https://www.ncbi.nlm.nih.gov/pubmed/30153967