ICD-10 for Atrioventricular (AV) block
Atrioventricular (AV) block involves impairment of the conduction between the atria and ventricles of the heart. In ICD-10-CM the codes are categorized by degree:
First degree AV block (I44.0 Atrioventricular block, first degree) – All atrial impulses reach the ventricles, but the conduction is delayed within the AV node. Patients are generally asymptomatic and the first-degree AV block is usually an incidental finding on electrocardiography (ECG). People with newly diagnosed first-degree AV block may be well-conditioned athletes, or they may have a history of myocardial infarction or myocarditis. First-degree AV block also may represent the first sign of degenerative processes of the AV conduction system.
Second degree AV block (I44.1 Atrioventricular block, second degree) – Atrial impulses fail to conduct to the ventricles. Patients may be asymptomatic, but may experience pre-syncope or syncope and sensed irregular heartbeats. The latter usually is observed in more advanced conduction disturbances, such as Mobitz II second-degree AV block. A history of medications that affect atrioventricular node (AVN) function (e.g., digitalis, beta-blockers, and calcium channel blockers) may be contributory and should be obtained. Other terms for a second degree AV block are Wenckebach’s and Mobitz blocks.
Third degree AV block (I44.2 Atrioventricular block, complete) – No supraventricular impulses are conducted to the ventricles. Patients have symptoms of fatigue, dizziness, light-headedness, pre-syncope, or syncope. Syncopal episodes due to slow heart rates are called Morgagni-Adams-Stokes (MAS) episodes, in recognition of the pioneering work of these researchers on syncope. Patients with third-degree AV block may have associated symptoms of acute myocardial infarction either causing the block or related to reduced cardiac output from bradycardia in the setting of advanced atherosclerotic coronary artery disease.
Proper coding of AV block requires documentation of severity:
- First degree
- Second degree
- AV block, type I and II
- Mobitz block, type I and II
- Second degree block, type I and II
- Wenckebach’s block
- Complete heart block
- Third degree block
Third-degree AV Block Example:
PREOPERATIVE DIAGNOSIS: Symptomatic 3rd-degree (complete) atrioventricular block.
POSTOPERATIVE DIAGNOSIS: Symptomatic 3rd-degree (complete) atrioventricular block.
PROCEDURE: Insertion of right atrial and right ventricular transvenous leads through the left subclavian vein and implantation of a dual-chamber permanent pacemaker.
DEVICE INFORMATION: Generator: St. Jude Medical. Model number: 5386. Serial number: 1146418. Right atrial lead: St. Jude Medical. Model number: 1888TC/52 cm. Serial number: BCK20068. Right ventricular lead: St. Jude Medical. Model number: 1 888TC158 cm. Serial number: BCLI6IO6.
DESCRIPTION OF PROCEDURE: After informed consent was obtained, the patient was transferred to the cardiac electrophysiology laboratory from the medical floor in a post absorptive and fasting state. The left upper chest area was prepped and draped in a sterile manner. A combination of a 50/50 portion with 1% Xylocaine and 0.25% Marcaine was used for a local anesthetic. A left infraclavicular skin incision was made, and a proper pocket was created subcutaneously. Substantial oozing from the subcutaneous tissue was noted during incision due to the fact that the patient was given Integrilin approximately 4 hours ago for cardiac catheterization prior to the pacemaker implantation, as well as the patient had been taking aspirin. The left subclavian vein puncture using a modified Seldinger technique was made without difficulty. Two separate cannulations for both atrial and ventricular access were made. After cannulation of the ventricular access, an active-fixation ventricular lead (6-French) was inserted through a 6-French SafeSheath into the right ventricular apex. An adequate threshold was achieved and as follows. Using a 0.4 msec pulse width, the ventricular voltage threshold was 1.4 V at 1.7 mA and impedance of 788 ohms with R wave amplitude of 3.8 mV.
The ventricular lead was secured with 0 Ethibond with 2 separate suture ligatures around the anchoring sleeve. A 6-French active-fixation atrial lead was inserted through another 6-French SafeSheath and was positioned in the right atrial appendage without difficulty. The threshold using a 0.4 pulse width was 1.4 V at 2.7 mA, impedance of 410 ohms, with a P wave amplitude of 1.8 mV. Ten-volt stimulation of both atrial and ventricular leads did not produce extra cardiac stimulation or diaphragmatic pacing. The atrial lead was likewise secured through the underlying muscular layer with 2 separate suture ligatures with 0 Ethibond around the anchoring sleeve. The pocket was thoroughly irrigated with antibiotic solution. Due to substantial oozing of the blood in the pocket, the wound was packed with hemostasis Surgicel sponge to enhance hemostasis. The terminal pins of both leads were securely connected to the pulse generator after proper programming of the parameters was made. The lower rate was set at 60 beats per minute and the upper tracking rate at 130 beats per minute with the atrioventricular delay at 170 ms in DDD mode. The pacemaker was implanted into the pocket and affixed to the underlying muscular layer with a single 0 Ethibond suture ligature.
The incision wound was closed with 2 layers of subcutaneous 3-0 Polysorb suture and a single layer of subcuticular 5-0 Polysorb sutures. The wound was cleaned and bandaged with sterile gauze and covered with transparent Tegaderm sheets. A pressure bandage was applied with an elastic bandage. The patient was transferred to the medical floor in stable condition. Conscious sedation was delivered by the EP lab nurse throughout the entire procedure.
CONCLUSION: Successful implantation of a dual-chamber permanent pacemaker.
DISPOSITION: The patient will be monitored on the floor with a chest X-ray and EGG taken today and in the morning. Pacemaker evaluation will be performed in the morning, and will be discharged per the floor team’s discretion. He will be seen at the Pacemaker Clinic in approximately 2 weeks for wound and pacemaker check. He will be periodically followed at our Pacemaker Clinic for a long-term follow-up.
ICD-10-CM Coding: I44.2.
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