Cardiology Coding Alert

Coding ICD-10-CM can be challenging, especially because you have so many choices to choose from. However, if you read the documentation carefully and pay attention to all the details, you will be able to select the correct code.

Step 1: First, Define Tachycardia for Clarity

Tachycardia is a type of arrhythmia — an abnormal rate or rhythm of a heartbeat. When a patient has tachycardia, their heart rate is higher than normal when they are at rest. You may see this diagnosis documented when the patient’s heart rate is more than 100 beats per minute (BPM).

Tachycardia sometimes has other symptoms as well, such as dizziness, shortness of breath, and chest pain. Common testing for tachycardia includes electrocardiograms (EKGs) and stress tests.

Step 2: Report Supraventricular Tachycardia Like This

Supraventricular tachycardia refers to a faster-than-normal heart rate that originates in the atria or the atrioventricular node. Different types of supraventricular tachycardia include the following:

• I47.10 (Supraventricular tachycardia, unspecified)
• I47.11 (Inappropriate sinus tachycardia, so stated). This code will include IST.
• I47.19 (Other supraventricular tachycardia). This code will include atrial (paroxysmal) tachycardia; atrioventricular [AV] (paroxysmal) tachycardia; atrioventricular re-entrant (nodal) tachycardia [AVNRT] [AVRT]; junctional (paroxysmal) tachycardia; and nodal (paroxysmal) tachycardia.

Don’t miss: Parent code notes for I47.1- instruct you to sequence the tachycardia complicating the following conditions first:

• O00.0 (Abdominal pregnancy) through O07 (Failed attempted termination of pregnancy)
• O08 (Complications following ectopic and molar pregnancy)
• O75.4 (Other complications of obstetric surgery and procedures)

Step 3: Rely on Multiple Codes for Ventricular Tachycardia

Ventricular tachycardia (VT) is a fast heart rhythm that starts in the lower chambers of the heart. Different types of VT include the following:

• I47.20 (Ventricular tachycardia, unspecified)
• I47.21 (Torsades de pointes). A code also note instructs you to also code I45.81 (Long QT syndrome) if applicable. You should also use an additional code for adverse effect, if applicable, to identify drug (T36- (Poisoning by, adverse effect of and underdosing of systemic antibiotics) through T50- Poisoning by, adverse effect of and underdosing of mineralocorticoids and their antagonists)
• I47.29 (Other ventricular tachycardia)

“Torsades de pointes arrhythmia is the result of a QT prolongation, which can be either a congenital condition or an acquired condition,” says Robin Peterson, CPC, CPMA, manager of professional coding and compliance services, Pinnacle Enterprise Risk Consulting Services, LLC in Centennial, Colorado. “The most typical reason for an acquired prolonged QT is drug related.”

Step 4: Bouveret-Hoffmann Syndrome is Type of Tachycardia

If you see “Bouveret-Hoffmann” in the cardiologist’s documentation, and you aren’t sure how to report it, don’t fear! Bouveret-Hoffmann is a type of paroxysmal tachycardia, so you would report I47.9 (Paroxysmal tachycardia, unspecified) for this condition.

Don’t miss: When you look under code I47.9 in the ICD-10-CM manual, you can see that Bouveret-Hoffmann syndrome is a covered condition for this code.

Step 5: See 6 Codes for Atrial Fibrillation

Another type of tachycardia is atrial fibrillation (A-fib). With A-fib, the atria quiver or fibrillate rather than beating normally. Your ICD-10-CM options for A-fib are as follows:

• I48.0 (Paroxysmal atrial fibrillation)
• I48.11 (Longstanding persistent atrial fibrillation)
• I48.19 (Other persistent atrial fibrillation). This code includes chronic persistent atrial fibrillation and persistent atrial fibrillation, NOS.
• I48.20 (Chronic atrial fibrillation, unspecified)
• I48.21 (Permanent atrial fibrillation)
• I48.91 (Unspecified atrial fibrillation)

Step 6: Learn 3 Codes for Atrial Flutter

Atrial flutter is also a kind of tachycardia. With atrial flutter, rapidly fired signals make the muscles in the atria contract quickly, which leads to a fast, steady heartbeat. Your ICD-10-CM options for atrial flutter are as follows:

• I48.3 (Typical atrial flutter). This code includes typical atrial flutter and Type I atrial flutter.
• I48.4 (Atypical atrial flutter). This code includes atypical atrial flutter and Type II atrial flutter.
• I48.92 (Unspecified atrial flutter).

Don’t miss: (A-fib) and atrial flutter are two different conditions, but if the documentation indicates that the patient has both, you can report both. However, you will need to check the documentation for more details to know exactly which A-fib and atrial flutter code to report.