I'm trying to correctly code this pt's dx. The pt had a syncopal episode was taken to the hospital, where she was found to have evidence of alternating bundle branch block. Now the pt. has a history LBBB, with prior history of documented RBBB w/ left anterior fascicular block.
Would I bill the alternating bundle branch block as 426.53 (bilateral), or 426.4 and 426.3 with the 780.2 as prime. Some help would really be appreciated.
REASON FOR CONSULTATION: For syncope in the setting of alternating bundle
branch block.
HISTORY OF PRESENT ILLNESS: is a pleasant 82-year-old with
history of left bundle branch block, with prior history of documented right
bundle branch block with left anterior fascicular block, hypertension and
dyslipidemia, who was transferred to Hospital to undergo
evaluation for implantation of pacemaker. Patient was apparently walking
outside, when she came back into her house. She suddenly developed a
syncopal episode without any prodrome. She was taken to the hospital, where
she was found to have evidence of alternating bundle branch blocks. As a
result, she was deemed a suitable candidate for pacemaker, hence the reason
for this consultation.
ALLERGIES: Patient has no known drug allergies.
MEDICATIONS: Timolol, lisinopril, latanoprost, fenofibrate, Zetia,
amlodipine, and aspirin.
PAST MEDICAL HISTORY:
1. Unheralded syncope without prodrome.
2. Alternating bundle branch blocks (history of a left bundle branch
block, history of branch bundle block, and left anterior fascicular
block).
3. Hypertension.
4. Dyslipidemia.
5. Glaucoma.
6. History of urinary tract infection.
FAMILY HISTORY: Negative for sudden cardiac death or cardiac arrhythmias.
SOCIAL HISTORY: Negative for tobacco and alcohol abuse.
REVIEW OF SYSTEMS:
Negative for orthopnea, PND, edema. Positive for frank syncope without
prodrome. Negative for any unexplained lightheadedness, dizziness, or near
syncope. Negative for other organ systems.
PHYSICAL EXAMINATION:
GENERAL: Patient is comfortable, in on acute distress.
VITAL SIGNS: Pulse rate 62, respirations 18, blood pressure 133/63.
HEENT: Normocephalic, atraumatic. Conjunctivae pink.
NECK: Supple. Without JVD or thyromegaly.
HEART: S1 and S2 audible, regular.
LUNGS: Clear.
ABDOMEN: Benign.
EXTREMITIES: No edema or cyanosis.
NEUROLOGIC: No focal neurologic deficits.
DIAGNOSTIC STUDIES: EKG shows sinus rhythm at a rate of 61 beats per
minute. PR interval 174 milliseconds, QRS duration of 156 milliseconds with
a left bundle branch block, QT interval of 477 milliseconds with no
significant ST or T-wave changes.
IMPRESSION:
1. Unheralded syncope without prodrome.
2. Alternating bundle branch blocks (history of a left bundle branch
block, history of a branch bundle block, and a left anterior fascicular
block).
3. Hypertension.
4. Dyslipidemia.
5. Glaucoma.
6. History of urinary tract infection.
RECOMMENDATIONS: I have discussed the indications and the procedure of
implantation of a permanent pacemaker under procedural sedation along with
its pros and cons and risks and benefits with the patient. She acknowledges
the above and would like to proceed. In view of her underlying alternating
bundle branch blocks and history of associated syncope, the procedure will
be at lab later today.
Thank you for allowing me to participate in this patient's management.
Preliminary Report - if not signed by author
Would I bill the alternating bundle branch block as 426.53 (bilateral), or 426.4 and 426.3 with the 780.2 as prime. Some help would really be appreciated.
REASON FOR CONSULTATION: For syncope in the setting of alternating bundle
branch block.
HISTORY OF PRESENT ILLNESS: is a pleasant 82-year-old with
history of left bundle branch block, with prior history of documented right
bundle branch block with left anterior fascicular block, hypertension and
dyslipidemia, who was transferred to Hospital to undergo
evaluation for implantation of pacemaker. Patient was apparently walking
outside, when she came back into her house. She suddenly developed a
syncopal episode without any prodrome. She was taken to the hospital, where
she was found to have evidence of alternating bundle branch blocks. As a
result, she was deemed a suitable candidate for pacemaker, hence the reason
for this consultation.
ALLERGIES: Patient has no known drug allergies.
MEDICATIONS: Timolol, lisinopril, latanoprost, fenofibrate, Zetia,
amlodipine, and aspirin.
PAST MEDICAL HISTORY:
1. Unheralded syncope without prodrome.
2. Alternating bundle branch blocks (history of a left bundle branch
block, history of branch bundle block, and left anterior fascicular
block).
3. Hypertension.
4. Dyslipidemia.
5. Glaucoma.
6. History of urinary tract infection.
FAMILY HISTORY: Negative for sudden cardiac death or cardiac arrhythmias.
SOCIAL HISTORY: Negative for tobacco and alcohol abuse.
REVIEW OF SYSTEMS:
Negative for orthopnea, PND, edema. Positive for frank syncope without
prodrome. Negative for any unexplained lightheadedness, dizziness, or near
syncope. Negative for other organ systems.
PHYSICAL EXAMINATION:
GENERAL: Patient is comfortable, in on acute distress.
VITAL SIGNS: Pulse rate 62, respirations 18, blood pressure 133/63.
HEENT: Normocephalic, atraumatic. Conjunctivae pink.
NECK: Supple. Without JVD or thyromegaly.
HEART: S1 and S2 audible, regular.
LUNGS: Clear.
ABDOMEN: Benign.
EXTREMITIES: No edema or cyanosis.
NEUROLOGIC: No focal neurologic deficits.
DIAGNOSTIC STUDIES: EKG shows sinus rhythm at a rate of 61 beats per
minute. PR interval 174 milliseconds, QRS duration of 156 milliseconds with
a left bundle branch block, QT interval of 477 milliseconds with no
significant ST or T-wave changes.
IMPRESSION:
1. Unheralded syncope without prodrome.
2. Alternating bundle branch blocks (history of a left bundle branch
block, history of a branch bundle block, and a left anterior fascicular
block).
3. Hypertension.
4. Dyslipidemia.
5. Glaucoma.
6. History of urinary tract infection.
RECOMMENDATIONS: I have discussed the indications and the procedure of
implantation of a permanent pacemaker under procedural sedation along with
its pros and cons and risks and benefits with the patient. She acknowledges
the above and would like to proceed. In view of her underlying alternating
bundle branch blocks and history of associated syncope, the procedure will
be at lab later today.
Thank you for allowing me to participate in this patient's management.
Preliminary Report - if not signed by author