AHA Coding Clinic® for ICD-10-CM and ICD-10-PCS - 2026 Issue 1; Clarifications and Corrections

Correction: NSTEMI due to Graft Thrombosis

In the scenario published in Coding Clinic, First Quarter 2024, page 28, the patient had a non-ST elevation myocardial infarction (NSTEMI). The culprit lesion of the patient’s myocardial infarction (MI) was the proximal stenosis of the vein graft to the obtuse marginal (OM) branches, with extensive thrombus seen in the distal graft. The advice was to assign code I21.4, Non-ST elevation (NSTEMI) myocardial infarction, as the principal diagnosis, with code I25.10, Atherosclerotic heart disease of native coronary artery without angina pectoris, for the multi-vessel native CAD, as an additional diagnosis. In a similar question published in Coding Clinic, Third Quarter 2021, page 6, the patient was admitted with chest pain and found to have “in-stent” restenosis in the previously placed coronary artery stents. In that case, the advice was to assign code T82.855A, Stenosis of coronary artery stent, initial encounter, as the principal diagnosis, with codes I21.A9, Other myocardial infarction type, and I25.10 as secondary diagnoses. This advice seems to conflict with the First Quarter 2024 advice. What are the appropriate codes/sequencing for a myocardial infarction (MI) due to a stenosed and thrombosed vein graft? ...

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