Anesthesia Coding Alert

Rely on the index to keep your coding for sinus tachycardia on the right path.

Cardiac conditions can sometimes increase the risk of administering anesthesia during a patient’s procedure. Such is the case with 785.0 (Tachycardia unspecified), which 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. 

ICD-9 coding rules: A note with 785.0 tells you that this code is appropriate for “Rapid heartbeat.” 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: Under ICD-10, you’ll be turning to R00.0 (Tachycardia unspecified) for a rapid heartbeat, instead of 785.0. But you won’t be using R00.0 exactly the same as your old go-to ICD-9 code.

Code R00.0, like 785.0, applies to rapid heartbeat 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, by contrast, you currently 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.

Coding 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).