Q: How would you code elevated troponin due to demand ischemia?
A: I would code I24.8 (other forms of acute ischemic heart disease). Per the Alphabetic Index, reference Ischemia, demand, I24.8, and do not report the elevated troponin. The elevated troponins in the bloodstream indicate that there has been damage to the heart muscle and therefore can be an indicator of demand ischemia or a heart attack. However, if there is no mention of a myocardial infarction (MI), a query might be appropriate.
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Demand ischemia is a transitory imbalance that may be caused by stresses to the heart. Patients may experience angina because of the increased oxygen demand. Demand ischemia may clinically reflect a troponin elevation where myocardial tissue has not been injured or damaged from necrosis. Elevated troponins in the blood stream indicate that there has been damage to the heart muscle, but it doesn’t cause the damage itself. It’s an indicator, like how a runny nose may indicate a patient may have a cold but does not always mean a patient has a cold. Demand ischemia can occur without a myocardial infarction (MI), so if there is no mention of an MI, a query might be appropriate.
The condition is frequently confused with type 2 MIs, and clarification may be needed to code the diagnosis reflective of the condition. A type 2 MI is a myocardial infarction secondary to ischemic imbalance (myocardial demand exceeding supply). This is where a condition other than coronary artery disease results in the imbalance between myocardial oxygen supply and/or demand. While demand ischemia due to elevated troponin levels can fit in the definition of a type 2 MI, it should not be coded as a type 2 MI unless an MI is documented.
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Editor’s Note: Adrienne Commeree, CPC, CPMA, CCS, CEMC, CPIP, a regulatory specialist for HCPro, an H3.Group division of Simplify Compliance LLC in Middleton, Massachusetts, answered this question during the HCPro webinar, “JustCoding’s 2018 ICD-10-CM Code Updates.” This answer was provided based on limited information. Be sure to review all documentation specific to your individual scenario before determining appropriate action.
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