# Stupid question on EKG



## heartyoga (Jun 10, 2019)

We have an EKG report as :

Interpretive Statements
Sinus Rhythm
Possible left atrial enlargement
Low QRS voltage in limb leads
Cannot rule out anterior infarct, probably old
Morphology grossly unchanged

Our coder coded as I50.23, I51.7, R94.31.

This patient was also seen as inpt for CHF, etc.

EKG report did not mention CHF but in fact patient has it as one of his dx as inpt. 

Is this correct?

Thanks.


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## kathrynw (Jun 13, 2019)

Hi,
First, code R94.31 is not appropriate to report when there is a definitive diagnosis given. See chapter specific guidelines. Secondly, are these diagnoses, i.e., I50.23 and I51.7, provided in the indications or on the order for the EKG? Because then they would be substantiated. I would review the order or indications for the diagnosis code, if not R94.31 might be your option.  

That being said, you wouldn't code I51.7 with I50.23 as cardiomegaly is a side effect/diagnostic qualifier of heart failure. Unless the documentation supports another cause or that they are unrelated. 

Hopefully this helps,


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## heartyoga (Jun 13, 2019)

Kathryn,

Thank you for your enlightening answers. Can you kindly provide which chapter i can find this? My coder is very obssessive with the rules and would need to see it on the ICD 10 book before accepting my answers. 

The R94.31 is what we use for the low QRS voltage. However, she insists on coding R94.31 even if there is atrial fibrillation as a first-code (which i disagree with).
Atrial fibrillation is an acceptable dx for EKG reading and interpretation. 

Thanks!


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