2027 ICD-10-CM Diagnosis Code I21.A1Myocardial infarction type 2
ICD-10-CM Codes›I00–I99›I20-I25›I21
- Billable — Valid for Submission
- MCC — Major Complication or Comorbidity
- Risk Adjusts — HCC 228
- Chronic Condition
I21.A1 is a billable ICD-10-CM diagnosis code for myocardial infarction type 2. It is valid on HIPAA claims for fiscal year 2027 (October 1, 2026 through September 30, 2027) and groups to MS-DRG 280 through 285. As a secondary diagnosis, it counts as a major complication or comorbidity (MCC) and places an inpatient stay in the highest severity level of its MS-DRG family. It does not count, however, when the principal diagnosis is one of 25 closely related codes. Coders also document this condition as myocardial infarction due to demand ischemia. In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Acute myocardial infarction.
For Medicare Advantage risk adjustment, I21.A1 maps to CMS-HCC Category 228 (Acute Myocardial Infarction) under the V28 model, adding a risk factor of about 0.252 for a community, non-dual, aged beneficiary in payment year 2027.
Code Identity
Code Classification
Medicare Risk Adjustment (HCC)Billing
I21.A1 maps to a payment category in the CMS-HCC model used to risk-adjust Medicare Advantage payments. Weights are the published community factors for payment year 2027.
Source: CMS Payment Year 2027 risk adjustment mappings and model software. Weights are relative factors, not dollar amounts; a beneficiary's total RAF also includes demographics and interactions. Browse all CMS-HCC categories.
Approximate SynonymsGuidance
Alternate terms and clinical phrases that map to this code.
- Myocardial infarction due to demand ischemia
Instructional NotesGuidance
Instructions from the official ICD-10-CM Tabular List that apply to I21.A1: its own notes plus those printed at I21, block I20-I25, and Chapter 9. A note printed at a category, block or chapter applies to every code under it.
Includes
Further defines, or gives examples of, the content of the category.
- cardiac infarction
- coronary (artery) embolism
- coronary (artery) occlusion
- coronary (artery) rupture
- coronary (artery) thrombosis
- infarction of heart, myocardium, or ventricle
- myocardial infarction specified as acute or with a stated duration of 4 weeks (28 days) or less from onset
Applicable To
Conditions this code is used for: synonyms of the title or, for "other specified" codes, the conditions assigned to it. The list is not exhaustive.
- Myocardial infarction due to demand ischemia
- Myocardial infarction secondary to ischemic imbalance
Excludes2
Not included here: the excluded condition is not part of this code, but a patient may have both, so both codes may be reported.
- certain conditions originating in the perinatal period (P04-P96)
- certain infectious and parasitic diseases (A00-B99)
- complications of pregnancy, childbirth and the puerperium (O00-O9A)
- congenital malformations, deformations, and chromosomal abnormalities (Q00-Q99)
- endocrine, nutritional and metabolic diseases (E00-E88)
- injury, poisoning and certain other consequences of external causes (S00-T88)
- neoplasms (C00-D49)
- symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R94)
- systemic connective tissue disorders (M30-M36)
- transient cerebral ischemic attacks and related syndromes (G45.-)
Code First
The underlying condition named in the note is sequenced before this code.
Use Additional Code
Add a second code, after this one, to fully describe the condition.
- code, if applicable, to identify:
- exposure to environmental tobacco smoke (Z77.22)
- history of tobacco dependence (Z87.891)
- occupational exposure to environmental tobacco smoke (Z57.31)
- status post administration of tPA (rtPA) in a different facility within the last 24 hours prior to admission to current facility (Z92.82)
- tobacco dependence (F17.-)
- tobacco use (Z72.0)
Code Also
A second code may be needed to fully describe the condition; the note gives no sequencing direction.
Source: CMS ICD-10-CM Tabular List. How to read instructional notes.
Referenced in Other NotesGuidance
Instructional notes printed at other codes that name I21.A1, its category, or a range that includes it.
Excludes1 4
These codes carry an Excludes1 note naming I21.A1: they are not reported together with it, unless the two conditions are unrelated.
- I22 Subsequent ST elevation (STEMI) and non-ST elevation (NSTEMI) myocardial infarctionsubsequent myocardial infarction, type 2 (I21.A1)
- I24.8 Other forms of acute ischemic heart diseasemyocardial infarction due to demand ischemia (I21.A1)
- I5A Non-ischemic myocardial injury (non-traumatic)acute myocardial infarction (I21.-) names I21.-, which includes this code
- I25.82 Chronic total occlusion of coronary artery
Excludes2 2
These codes carry an Excludes2 note naming I21.A1: its condition is not part of those codes, and both may be reported when the patient has both.
Code First 1
These codes say to code first a condition named in the note, and I21.A1 is one of the conditions named.
Index to Diseases and InjuriesGuidance
Alphabetical index entries that point to this code.
demand (coronary) See Also: Angina; I24.89
with myocardial infarction I21.A1
Clinical ClassificationClinical
AHRQ’s CCSR groups this code into broader clinical categories.
Clinical InformationClinical
Acute Myocardial Infarction
necrosis of the myocardium, as a result of interruption of the blood supply to the area. it is characterized by a severe and rapid onset of symptoms that may include chest pain, often radiating to the left arm and left side of the neck, dyspnea, sweating, and palpitations.
Patient EducationClinical
Heart Attack
A heart attack, also called a myocardial infarction, is a type of heart disease. It happens when blood flow to the heart suddenly becomes blocked. Without the blood coming in, the heart can't get oxygen. If not treated quickly, the heart muscle begins to die.
The full article covers:
- What is a heart attack?
- What heart attack risk factors can be changed?
- What heart attack risk factors can't be changed?
- What causes a heart attack?
- What are the symptoms of a heart attack?
- How is a heart attack diagnosed?
- What is the treatment for a heart attack?
Read the full article at MedlinePlus
Courtesy of MedlinePlus, a service of the U.S. National Library of Medicine.
Convert I21.A1 to ICD-9-CMHistory
The closest ICD-9-CM equivalents under the General Equivalence Mappings.
Code History & ChangesHistory
Replacement I21.A1 replaces the following previously assigned code(s):
- I21.3 - ST elevation (STEMI) myocardial infarction of unsp site
Questions About I21.A1Overview
What is the ICD-10 code for myocardial infarction type 2?
The ICD-10-CM code for myocardial infarction type 2 is I21.A1 (sometimes written as I21A1). It is billable on HIPAA-covered claims from October 1, 2026 through September 30, 2027.
Is I21.A1 (Other type of myocardial infarction) a billable code?
Yes. This is a billable ICD-10-CM code, specific enough to report myocardial infarction type 2 on HIPAA-covered claims from October 1, 2026 through September 30, 2027.
What MS-DRG does I21.A1 group to?
When myocardial infarction type 2 is the principal diagnosis on an inpatient stay, it groups to MS-DRG 282, 285, 281, 280, 283, 284, with relative weights from 0.5197 to 1.9615 depending on complications. Higher weights mean higher Medicare reimbursement.
Is I21.A1 a CC or MCC?
CMS lists I21.A1 as an MCC (major complication or comorbidity) for FY 2027. Reported as a secondary diagnosis, it places the inpatient stay in the highest-weighted DRG of its severity family. It does not count when the principal diagnosis is one of the 25 closely related codes in its exclusion list.
Does I21.A1 need an additional code?
When the condition applies, yes. The Use Additional Code note at I21, which applies to I21.A1, reads: code, if applicable, to identify: exposure to environmental tobacco smoke (Z77.22); history of tobacco dependence (Z87.891); occupational exposure to environmental tobacco smoke (Z57.31); status post administration of tPA (rtPA) in a different facility within the last 24 hours prior to admission to current facility (Z92.82); tobacco dependence (F17.-); and 1 more listed in the Instructional Notes section. The additional code is reported after I21.A1.
What HCC is I21.A1?
I21.A1 (myocardial infarction type 2) maps to CMS-HCC Category 228 (Acute Myocardial Infarction), commonly written as HCC 228, in the CMS-HCC V28 model used for Medicare Advantage risk adjustment in payment year 2027. It mapped to HCC 86 under the retired V24 model. It also maps in the PACE (CMS-HCC V22), ESRD (V21), and ESRD (V24) models. In the Part D prescription drug model it maps to RxHCC 188.
Does I21.A1 risk-adjust for Medicare Advantage payment?
Yes. When documented and reported on a Medicare Advantage encounter, I21.A1 adds a risk adjustment factor of about 0.252 to the beneficiary's RAF score for a community, non-dual, aged enrollee (published V28 weights range from 0.252 to 0.517 depending on the payment segment). HCC 228 sits at the top of its hierarchy, so no other condition category supersedes it. See the full factor table on the HCC 228 category page.
