ICD 10 Coding Alert

Term swap: ICD-10 uses ‘depolarization’ instead of ‘beats.’

Many Part B practices see patients with premature heartbeat disorders, so you may have those diagnosis codes at the top of your mind. But in your preparations for ICD-10, pay attention to two key premature beat coding changes to ensure clear sailing for your claims.

ICD-9-CM Codes:

• 427.60, Premature beats unspecified
• 427.61, Supraventricular premature beats
• 427.69, Other premature beats

ICD-10-CM Codes:

• I49.1, Atrial premature depolarization
• I49.3, Ventricular premature depolarization
• I49.40, Unspecified premature depolarization
• I49.49, Other premature depolarization

Diagnosis: A premature heartbeat is an extra beat that comes earlier than a regular heartbeat. The patient may say it feels like her heart skipped a beat. A premature atrial contraction arises from the heart’s upper chambers, the atria. Premature ventricular contractions arise from the heart’s lower chambers, the ventricles.

ICD-9 coding rules: ICD-9 includes one code for unspecified premature beats (427.60). It applies to ectopic beats, extrasystoles, extrasystolic arrhythmia, and premature contractions or systoles that are not otherwise specified. You use a different code, 427.61, for supraventricular premature beats, including premature beats, contractions, or systoles documented as atrial. Finally you have 427.69 for all other premature beats, including ventricular premature beats, contractions, or systoles.

ICD-10 changes: The first thing you may notice about the ICD-10 codes is that they refer to "depolarization" rather than "beats." Depolarization relates to electrical stimulation causing contraction of the heart muscle. The second thing you may notice is that ICD-10 divides your code choices based on atrial (I49.1), ventricular (I49.3), unspecified (I49.40), and other (I49.49). So unlike ICD-9, ICD-10 doesn’t lump "ventricular" in with "other."

Documentation: Be sure ICD-10 tools allow the physician to easily mark atrial, ventricular, or other types. If your physician knows whether the patient has ventricular or atrial premature beats, he should be documenting that already. But if your charge tickets or other tools are based on coding, the staff may be trained to look only for atrial premature beats because ICD-9 includes ventricular under the "other" code. This won’t work for ICD-10’s more specific codes.

Also watch the documentation for ectopic beats, extrasystoles, extrasystolic arrhythmias, and premature contractions, which ICD-10 places under "other" code I49.49. And don’t miss that "Premature beats NOS" falls under unspecified code I49.40.

Coder tips: If you look in the I49.- range, you’ll see another depolarization code: I49.2 (Junctional premature depolarization). Medicare General Equivalency Mappings (GEMs) cross this to 427.0 (Paroxysmal supraventricular tachycardia) rather than to an ICD-9 "premature beat" code.

Also be sure to review the rules that apply to the I49.- range as a whole. You should "code first" cardiac arrhythmia complicating abortion or ectopic or molar pregnancy (O00-O07, O08.8-) or obstetric surgery and procedures (O75.4). The I49.- range excludes neonatal dysrhythmia (P29.1-) and a number of bradycardia diagnoses assigned to unspecified bradycardia code R00.1 (NOS, sinoatrial, sinus, and vagal).