Cardiology Coding Alert

Question: The patient had a positive result for T-wave alternans. What ICD-9 code should I use for this diagnosis?


Connecticut Subscriber

Answer: You have a variety of options that depend on your cardiologist's documentation.

If the T-wave alternans testing reveals a specific form of arrhythmia, you would report that as the primary diagnosis (such as 427.1, Paroxysmal ventricular tachycardia; 427.41, Cardiac dysrhythmias; ventricular fibrillation and flutter; ventricular fibrillation; 427.42, Ventricular flutter; or 427.69, Other premature beats).

Remember: You'll report the specific finding of the test as a stand-alone diagnosis. In other words, you won't need a secondary code.

If the test report provides nothing more than an indication that the T-wave alternans test was positive, you will probably be stuck reporting a more generic diagnosis, such as 794.30 (Abnormal cardiovascular function study, unspecified) or 794.31 (Abnormal electrocardiogram [ECG] [EKG]).

Note: Some cardiologist think that patients with symptoms of life-threatening arrhythmias are at higher risk for sudden cardiac death (SCD) if they test positive for T-wave alternans. Others think that the jury is out regarding the significance of T-wave alternans testing. Regardless, CMS is carefully looking at this form of testing. The medical community is also looking at it as well to determine if T-wave alternans testing will more accurately identify patients at increased risk. Using the right ICD-9 code will help provide medical necessity for further tests and procedures.