Ask Dr. Z

In coding clinic 1st quarter 2024, there was a question and answer for angina with MI. "Assign code I21.4, Non-ST elevation (NSTEMI) myocardial infarction, as the principal diagnosis. Assign code I25.10, Atherosclerotic heart disease of native coronary artery without angina pectoris, for the multi-vessel native CAD, as an additional diagnosis. It would be inappropriate to assign a code for angina in the setting of an MI." Can you explain why we would not code angina with a MI? This seems like new guidance. In the Coding Guidelines 1.C.9 Atherosclerotic Coronary Artery Disease and Angina it mentions "If a patient with coronary artery disease is admitted due to an acute myocardial infarction (AMI), the AMI should be sequenced before the coronary artery disease." but does not mention anything about angina with the CAD in this statement. What are your thoughts on angina with MI?