Anesthesia Coding Alert
Assign Tachycardia Codes Without Missing a Beat
Hint: Use atrial rate to distinguish typical from atypical atrial flutter. When you come across documentation of tachycardia, arriving at the right code can be challenging because ICD-10-CM offers a slew of different options to enable maximum specificity. You’ll need to know several key facts before you can code your claim. To ensure you’re up to speed on how to report a fast heart rate and the many nuances a diagnosis of tachycardia encompasses, check out the answers to these FAQs. Peruse the Particulars of Tachycardia FAQ 1: What is tachycardia? Answer: Tachycardia is a kind of arrhythmia in which a patient’s heart beats too quickly. Specifically, tachycardia is defined as a heart rate of more than 100 beats a minute at rest. Many types of irregular heart rhythms, or arrhythmias, cause the heart to beat too fast. Tachycardia is sometimes accompanied by other symptoms as well, such as dizziness, shortness of breath, and chest pain, says Rebecca Sanzone, CPC, CPMA, compliance administrator at St. Vincent Medical Group/Ascension Health in Indianapolis. Common diagnostic testing for tachycardia includes electrocardiography (EKG), Holter monitor, stress test, and echocardiography. Distinguish Types of Tachycardia FAQ 2: What are the various types of tachycardia? Answer: There are many different types of fast heart rhythms. For example, sinus tachycardia refers to a typical increase in the patient’s heart rate, often caused by exercise or stress. Other types of tachycardia are categorized based on the part of the heart responsible for the fast heart rate and the cause. Common types of tachycardia caused by arrhythmias include the following, per Sanzone: Look to Code I47.20 for Sustained, Non-Sustained VT FAQ 3: What ICD-10-CM code should I report for ventricular tachycardia (VT)? Answer: You should report I47.20 (Ventricular tachycardia, unspecified) for VT, Sanzone says. Ventricular tachycardia is a fast heart rhythm that starts in the lower chambers of the heart (ventricles). Code I47.20 covers sustained ventricular tachycardia and non-sustained ventricular tachycardia. If the documentation indicates torsades de pointes (TdP), you should report I47.21 (Torsades de pointes). Understand Multiple Included Conditions for I47.1 FAQ 4: Which ICD-10-CM code should I report for supraventricular tachycardia (SVT)? Answer: You should report I47.1 (Supraventricular tachycardia) for SVT. Supraventricular tachycardia (SVT) is a faster-than-normal heart rate that originates above the ventricles — in the upper chambers of the heart (atria) or the atrioventricular (AV) node. Included conditions for I47.1: Don’t miss: A code first note instructs you to sequence tachycardia complicating the following conditions first, followed by I47.1: Differentiate Atrial Fibrillation From Atrial Flutter FAQ 5: What is the difference between atrial fibrillation and atrial flutter, and which ICD-10-CM codes should I report for each of these conditions? Answer: Atrial flutter and A-fib are both fast heart rates, but heartbeats in AFL are more organized. In other words, the heart rhythm in AFL is regular, whereas the rhythm in A-fib is irregular. Here is a breakdown of the specifics. Atrial fibrillation: With A-fib, chaotic, irregular electrical signals in the atria cause a fast heartbeat and atrial quivering (fibrillating) rather than beating normally. Your ICD-10-CM options for atrial fibrillation are as follows: Paroxysmal atrial fibrillation is described as occurring spontaneously and resolving spontaneously, usually within 48 hours, and can be recurrent, says Robin Peterson, CPC, CPMA, manager of professional coding services, Pinnacle Integrated Coding Solutions, LLC. Persistent atrial fibrillation is defined as atrial fibrillation that does not terminate within seven days; whereas longstanding persistent atrial fibrillation is defined as persistent and continuous atrial fibrillation, which lasts longer than a year. “According to AHA Coding Clinic Vol. 6, No. 4, ‘the term chronic atrial fibrillation could mean persistent, longstanding persistent, or permanent, and the more specific term is preferred over the nonspecific term ‘chronic,’” Peterson says. “Also, the term ‘chronic persistent atrial fibrillation’ has no widely accepted clinical definition or meaning and should be coded as ‘other persistent atrial fibrillation.’” Atrial flutter: With atrial flutter, rapidly fired signals make the atrial myocardium contract quickly, which leads to a fast, steady heartbeat. Your ICD-10-CM options for atrial flutter are as follows: Overcome Tachycardia Coding Challenges FAQ 6: What advice do you have for coders who are new to cardiology and having a tough time understanding how to correctly report tachycardia? Answer: Many coders just report tachycardia with the unspecified code R00.0 (Tachycardia, unspecified), says Catherine Brink, BS, CPC, CMM, president of Healthcare Resource Management in Spring Lake, New Jersey. “If that is what is documented in the medical record, then it is correct. However, it is important to note that ‘unspecified’ codes may not support the medical necessity of the service rendered.” Brink adds that coders should educate their providers about the importance of specifying the specific type of tachycardia the patient has in the medical documentation. “Of course, if the provider cannot specify the exact type of tachycardia, then the documentation would be ‘unspecified tachycardia — R00.0,’” Brink adds. Sanzone agrees that knowing the specific type of tachycardia is key to correct coding. You must know if the type of tachycardia has been determined by capture on a test, such as an EKG or stress test, Sanzone says. “You do not want to code someone with SVT or VT if they are just having sinus tachycardia. You need specifics to code properly.”
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