Cardiology Coding Alert

Tip 1: Observe What Bradycardia Is

A patient with bradycardia usually has fewer than 60 beats per minute, says Rebecca Sanzone, CPC, CPMA, quality assurance specialist at St. Vincent Medical Group/Accension Health and coding consultant at the American College of Cardiology. At this rate, the heart is not able to pump enough oxygen-rich blood to the body during normal activity or exercise. As a result, patients may feel dizzy or have chronic lack of energy, shortness of breath, or even fainting spells.

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.

Code R00.1 covers sinus bradycardia, slow heartbeat, and vagal bradycardia, according to Carol Hodge, CPC, CPMA, CDEO, CCC, CEMC, CPB, CFPC, COBGC, senior documentation specialist at St. Joseph’s/Candler Medical Group.

Another cause of bradycardia is atrioventricular (AV) block, Hodge says. It is essential that the provider clearly documents the type of bradycardia the patient has in order to successfully select the correct code.

Coding tip: Per 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: I49.5 is Correct for Sick Sinus Bradycardia

Report I49.5 for sick sinus syndrome, says Catherine Brink, BS, CPC, CMM, president of Healthcare Resource Management in Spring Lake, New Jersey.

The heart’s natural pacemaker is the sinus node, Hodge says. If the bradycardia is caused by a dysfunction of the sinus node, it is called sick sinus syndrome.

Sick sinus syndrome refers to a collection of disorders marked by the heart’s inability to perform its pacemaking function, Sanzone adds. Predominantly affecting older adults, sick sinus syndrome comprises various arrhythmias, including bradyarrhythmias with or without accompanying tachyarrhythmias

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

Tachycardias (rapid heart rhythms) that start in the upper chambers of the heart may also be part of the sick sinus syndrome, according to Sanzone. These include atrial fibrillation, atrial flutter, and atrial tachycardia. A period of fast heart rates is often followed by very slow heart rates.

When there are periods of both slow and fast heart rates (rhythms) the condition often will be called tachy-brady syndrome. You would report this condition with I49.5, as well.

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.

Coding tip: 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).

Tip 4: Be Aware of Common Coding Challenges

Many challenges may arise when reporting for bradycardia. For example, just knowing the specific type of arrhythmia can be problematic.

There are many things that fall into the class of “cardiac arrhythmia,” Sanzone says. The documentation must be specific before you can code appropriately.

Bradycardia should only be coded for “slow heart rate.” If other signs/symptoms are reported, they should be coded as well, Sanzone adds. If there are other findings such as left bundle branch block or premature atrial contractions on a diagnostic test like an electrocardiogram (ECG), then also report those.

Borderline or occasional bradycardia may not require treatment, according to Sanzone. On the other hand, severe or prolonged bradycardia can be treated in a few ways. For instance, if medication side effects are causing the slow heart rate, the medication regimen can be adjusted or discontinued. In many cases, a pacemaker can regulate the heart’s rhythm, speeding up the heart rate as needed.