Anesthesia Coding Alert

The first-stop descriptor isn’t always your best choice.

A patient having a history of rapid heart beat, also known as tachycardia, is a special consideration for your anesthesia provider before and during surgery. Be aware that you’ll be turning to R00.0 for a rapid heart beat in ICD-10, instead of 785.0 that you’ve used for years. But – experts say you won’t be using R00.0 exactly the same as your old go-to ICD-9 code.

Descriptors: The descriptor for unspecified tachycardia is identical under ICD-9 and ICD-10. It simply reads, “Tachycardia unspecified” for both 785.0 and R00.0. 

ICD-9 coding rules: A note with 785.0 tells you that this code is appropriate for “Rapid heart beat.” However, Excludes notes tell you not to use 785.0 for neonatal tachycardia (779.82), paroxysmal tachycardia (427.0-427.2), or heart failure NOS (428.9).

ICD-10 changes: While the descriptor for R00.0 is essentially the same as the descriptor for 785.0, there are both similarities and differences in the notes and indexing. 

Code R00.0, like 785.0, applies to rapid heart beat and excludes neonatal tachycardia (P29.11) and paroxysmal tachycardia (I47.-).

However, be sure to note that R00.0 applies to sinoauricular tachycardia NOS and sinus [sinusal] tachycardia NOS, according to notes with R00.0. 

Under ICD-9, you report sinoauricular tachycardia and sinus tachycardia using 427.89 (Other specified cardiac dysrhythmias), not 785.0.

Documentation: Code R00.0, like 785.0, is an unspecified code, indicating the cardiologist didn’t document the specific type of tachycardia. When possible, the cardiologist should specify the type of tachycardia so you can select a more precise code. A more precise code better supports medical necessity for payers.

Coder tips: Only use R00.0 when the cardiologist doesn’t offer details for a more specific code. For instance, if the documentation shows atrial paroxysmal tachycardia, you should report I47.1 (Supraventricular tachycardia).

Tachycardia is a higher than normal heart rate when the patient is at rest. You may see this diagnosis documented when the patient’s heart rate is more than 100 beats per minute, or BPM.

Remember: The clock is ticking toward the Oct. 1, 2015, as the new compliance date for ICD-10. When ICD-10-CM goes into effect, you should apply the code set and official guidelines in effect for the date of service reported. Learn more at www.cms.gov/ICD10/ and www.cdc.gov/nchs/icd/icd10cm.htm#10update .