Cardiology Coding Alert

Remember to look to combo codes if the left bundle branch is affected, too.

ICD-10 tweaks the terminology and coding for right bundle branch blocks. Here are the details.

ICD-9-CM Code:

• 426.4, Right bundle branch block

ICD-10-CM Codes:

• I45.0, Right fascicular block
• I45.10, Unspecified right bundle-branch block
• I45.19, Other right bundle-branch block

Diagnosis: After the heart’s electrical impulse passes through the A-V node (between the atria and ventricles), the impulse passes along the bundle of His, which divides into a left bundle and a right bundle. If the impulse is slowed or stopped along the right bundle branch, the patient has right bundle branch block (RBBB).

ICD-9 coding rules: ICD-9 offers one code for RBBB alone, 426.4. But you use 426.5x codes to represent blocks affecting both the left and right branches, such as 426.51 (Right bundle branch block and left posterior fascicular block) and 426.54 (Trifascicular block).

ICD-10 changes: Rather than having just one RBBB code, ICD-10 includes codes specific to right fascicular block (I45.0), unspecified RBBB (I45.10), and other RBBB (I45.19). If the patient has both right and left fascicular blocks, then you’ll instead use codes such as I45.2 (Bifascicular block) and I45.3 (Trifascicular block).

Documentation: If your clinicians’ documentation specifies the type of right block, you’re golden for ICD-10. All you need to do as a coder to capture this already present information is to format your superbill to capture the difference between right fascicular block, “other,” and “unspecified” RBBB. “Other” means the physician documented the type, but ICD-10 doesn’t offer a code specific to the documented type. “Unspecified” means the physician did not document the type of RBBB.

Coder tips: Alert the clinical staff that the superbill will change in response to the separate fascicular, “other,” and “unspecified” codes. As an example, ICD-10 indexes Wilson’s type to “other” code I45.19. “Block, bundle-branch, right” is indexed to I45.10.

Remember: CMS has finalized the ICD-10 compliance date of Oct. 1, 2014. When ICD-10 is implemented, 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.