Hello,

I feel that there is a potential issue with this measure as it pertains to the coding of STEMI patients who have had a prior STEMI equal to or less than four weeks prior to the patient returning for a different reason or a reason in relation to the first STEMI. Our coders are assigning the I21 ICD-10 codes to this population of "recent STEMIs." This is causing those patients to fail the measure because they are not having an active STEMI. An example is that one patient came in with wrist pain from a prior PCI that occurred at a different facility. They were coded with the "I21.09 ST elevation (STEMI) myocardial infarction involving other coronary artery of anterior wall" diagnosis code, but the STEMI had occurred 16 days before this ED visit. Since the patient did not come in with an active STEMI, but the I21.09 was assigned by coding based on their coding guidelines, this patient would not be treated for a STEMI (fibrinolytics, PCI, or a transfer for PCI) because they were not having an active STEMI.

It is clear that this measure does not align with the coding guidelines related to the section: Readmission post myocardial infarction; ICD-10-CM/PCS Coding Clinic, Fourth Quarter ICD-10 2016 Page 140 Effective with discharges: October 1, 2016