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Comment & Response
August 14, 2019

ICD-10 Coding of Type 2 Myocardial Infarction and Myocardial Injury as It Relates to US Centers for Medicare & Medicaid Services Value-Based Payment Programs

Author Affiliations
  • 1Division of Cardiology, Department of Medicine, School of Medicine, University of Colorado, Aurora
  • 2Quality and Safety Committee, Department of Medicine, School of Medicine, University of Colorado, Aurora
JAMA Cardiol. Published online August 14, 2019. doi:10.1001/jamacardio.2019.2818

To the Editor We read with great interest the article by McCarthy et al1 entitled “Misclassification of Myocardial Injury as Myocardial Infarction: Implications for Assessing Outcomes in Value-Based Programs.” Our experience has been consistent with the authors’ observation that nonischemic myocardial injury is often confused with type 2 myocardial infarction (MI) or even type 1 MI. We have also observed that patients with type 2 MI and myocardial injury are often included in incentive programs, such as the Hospital Readmissions Reduction Program and Hospital Value-Based Purchasing program, as a result of incorrect attribution in coding.2 In a 2018 study,3 more than 25% of patients who were coded as having a type 1 MI actually had a type 2 MI. In light of this, we viewed the advent of a new International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) code for type 2 MI as a potential opportunity to more appropriately code, and thus differentiate, these patients.