With the current ICD-10-CM code set, there is no specific code corresponding to non-traumatic myocardial injury. Given the high severity of illness typical of patients with non-ischemic myocardial injury, appropriate classification of these patients is paramount in terms of aligning appropriate diagnostic and treatment strategies while avoiding inappropriate approaches that would otherwise be suggested by miscoding.
A request has been received from the American College of Cardiology to create a new code – I5A Non-ischemic myocardial injury – for nonischemic myocardial injury. The need for clinicians to document whether patients have either a non-ischemic etiology of myocardial injury or one of the MI subtypes has thus been heightened. Where there is a lack of evidence suggesting myocardial ischemia, a diagnosis of myocardial injury is to be made.
Ischemic myocardial injury, which is synonymous with myocardial infarction, is already well delineated in the ICD-10-CM coding schema in sections I21.- and I22.-; traumatic myocardial injury is delineated in section S26.-. Since myocardial infarction and traumatic myocardial injury will typically be described in clinical documentation, we recommend that documentation referring to “myocardial injury” without concomitant documentation of myocardial infarction or trauma default to non-ischemic, non-traumatic myocardial injury per the proposed new code.
Below are the Tabular modifications that will be made to accommodate the addition of this new code:
I5A Non-ischemic myocardial injury (non-traumatic)
Includes:
- Acute (non-ischemic) myocardial injury
- Chronic (non-ischemic) myocardial injury
- Unspecified (non-ischemic) myocardial injury
Code first the underlying cause, if known and applicable, such as:
- Acute kidney failure (N17.-)
- Acute myocarditis (I40.-)
- Cardiomyopathy (I42.-)
- Chronic kidney disease (CKD) (N18.-)
- Heart failure (I50.-)
- Hypertensive urgency (I16.0)
- Nonrheumatic aortic valve disorders (I35.-)
- Paroxysmal tachycardia (I47.-)
- Pulmonary hypertension (I27.0, I27.2)
- Pulmonary embolism (I26.-)
- Sepsis (A41.-) Takotsubo syndrome (I51.81)
Excludes1: Acute myocardial infarction (I21.-) and Injury of heart (S26.-)
Excludes2: Other acute ischemic heart diseases (I24.-)