Code I5A, Non-ischemic myocardial injury (non-traumatic), has been created to identify a non-traumatic, non-ischemic myocardial injury. The definition of a non-ischemic myocardial infarction (MI) was most recently updated in 2018.
According to the Fourth Universal Definition of Myocardial Infarction, an acute myocardial injury is characterized by the rise and/or fall of cardiac troponin levels with at least one value above the 99th percentile upper reference limit. A diagnosis of MI is reserved for patients with myocardial ischemia as the cause of myocardial injury, whether attributable to acute atherothrombosis (type 1 MI) or supply/demand mismatch without acute atherothrombosis (type 2 MI). Myocardial injury in the absence of ischemia is categorized as acute or chronic nonischemic myocardial injury. Based on high sensitivity troponin tests, clinicians can now distinguish whether patients have suffered a non-ischemic myocardial injury versus one of the other MI subtypes. This new code will allow for the appropriate classification of these patients.
When assigning code I5A, sequence the underlying cause first, such as acute kidney failure, acute myocarditis, etc., if known and/or applicable.
A patient presents to the Emergency Department after becoming progressively somnolent. Diagnostic workup revealed elevated troponin level and intermittent atrial fibrillation and the patient was admitted for further cardiology management. The patient never reported any chest pain; did not demonstrate electrocardiogram (ECG) changes; troponin levels stabilized; and at discharge, the provider diagnosed non-ischemic myocardial injury. How would non-ischemic myocardial injury be coded?
Assign code I5A, Non-ischemic myocardial injury (non-ischemic), for non-ischemic myocardial injury.