Cardiology Coding Alert

Hint: Code R00.1 includes sinus bradycardia.

Bradycardia, like many other type of conditions you report on your claims, can be challenging because ICD-10-CM offers many different options for specificity. For example, to successfully code bradycardia, you must know what type of bradycardia the patient has, if it is actually bradycardia and not another condition, and consider any special coding notes that might apply.

Keep the following handy tips in mind when you report bradycardia.

Tip 1: First, Understand What Bradycardia Is

Bradycardia is a type of arrythmia, which is defined as an abnormal rate or rhythm of the heartbeat. The heart can beat too fast, too slow, or with an irregular rhythm. A heartbeat that is too fast is called tachycardia, and a heartbeat that is too slow is bradycardia.

Reporting arrhythmias can be a challenge because there is such a wide variety of arrhythmias and a wide variety of causes, says Carol Hodge, CPC, CPMA, CDEO, CCC, CEMC, CPB, CFPC, COBGC, senior documentation specialist at St. Joseph’s/Candler Medical Group. Coders should be proficient in medical terminology and anatomy to be sure they are selecting the correct ICD-10 code.

Bradycardia defined: Usually, an adult at rest will have a heartbeat of 60 to 100 times a minute. A patient with bradycardia will have a heartbeat of fewer than 60 beats a minute (BPM).

However, there can be certain exceptions to this, according to the American Heart Association (AHA). For example, a patient’s heart rate could fall below 60 beats per minute when they are sleeping.

Expert Catherine Brink, BS, CPC, CMM, president of Healthcare Resource Management in Spring Lake, New Jersey, offers insights regarding common coding challenges you may encounter when reporting arrhythmias such as bradycardia.

“Always code from the medical documentation by the provider. If the medical record diagnosis is hypotension, then that should be the correct code rather than bradycardia, which is a heart rate below 60 bpm,” says Brink. “If there are underlying medical conditions documented, they should be coded as well. The sequencing of diagnosis codes depends on the primary medical condition, for example, bradycardia, and the underlying medical conditions, comorbidities, or heart disease that affects the bradycardia.”

To successfully report bradycardia, you must understand the definition of bradycardia versus hypotension and be able to read the medical documentation for any underlying medical conditions and comorbidities, Brink reiterates.

Tip 2: Rely on R00.1 for Sinus Bradycardia

Sinus bradycardia is a type of bradycardia that originates from the sinus node of the heart. This condition is most common in patients who exercise regularly or are over age 65.

Report R00.1 (Bradycardia, unspecified) for sinus bradycardia. Although the code description points to “unspecified bradycardia,” if you look in the ICD-10-CM code book, you will see that code R00.1 also includes the following conditions:

• Sinoatrial bradycardia
• Sinus bradycardia
• Slow heart beat
• Vagal bradycardia

Don’t miss: According to ICD-10-CM, you should also report an additional code for adverse effect, if applicable, to identify the drug causing the bradycardia from categories T36- (Poisoning by, adverse effect of and underdosing of systemic antibiotics) through T50- (Poisoning by, adverse effect of and underdosing of diuretics and other and unspecified drugs, medicaments and biological substances) when you report R00.1.

Tip 3: Patient Has Sick Sinus Syndrome? Do This

Sick sinus syndrome is another type of bradycardia you may see in documentation. Report I49.5 (Sick sinus syndrome) for this condition, Hodge says.

Don’t miss: If you choose I49.5, you should “code first” cardiac arrhythmia complicating abortion or ectopic or molar pregnancy (O00-O07, O08.8) or obstetric surgery and procedures (O75.4).

Sick sinus syndrome refers to a collection of disorders marked by the heart’s inability to perform its pacemaking function, according to Rebecca Sanzone, CPC, CPMA, quality assurance specialist at St. Vincent Medical Group/Accension Health and coding consultant at the American College of Cardiology. Predominantly affecting older adults, sick sinus syndrome comprises various arrhythmias, including bradyarrhythmia with or without accompanying tachyarrhythmias.

Normally, the heartbeat starts in an area in the top chambers of the heart (atria), Sanzone says. This area is the heart’s pacemaker and is called the sinoatrial node, sinus node, or SA node. Its role is to keep the heart beat steady and regular.

Sick sinus syndrome is uncommon but not rare, according to Sanzone. It is the most common reason people need to have an artificial pacemaker implanted.

Included condition: Code I49.5 also includes tachycardia-bradycardia syndrome. This condition occurs when the patient’s heart sometimes beats too quickly (tachycardia) and sometimes beats too slowly (bradycardia). Often patients who have atrial fibrillation will experience tachycardia-bradycardia syndrome.

Patients with tachycardia-bradycardia syndrome may have palpitations and lightheadedness. They may also pass out and be at a higher risk of stroke. Your cardiologist may insert a pacemaker for patients with tachycardia-bradycardia syndrome to keep the heart from beating too slowly. Or your cardiologist may prescribe medication to prevent the heart from beating too fast.