Anesthesia Coding Alert

Tip 1: First, Understand What Bradycardia Is

Bradycardia is a type of arrhythmia, which is defined as an abnormal rate or rhythm of the heartbeat. The heart can beat too fast (tachycardia), too slow (bradycardia), or with an irregular rhythm (dysrhythmia). In some cases, bradycardia doesn’t cause any symptoms. But if the heart rate is very slow and the heart can’t pump enough oxygen-rich blood to the body, a patient may feel dizzy, very tired or weak, and short of breath.

Reporting arrhythmias can be a challenge because there is such a wide variety of arrhythmias and a wide variety of causes, says Carol Hodge, CPC, CPMA, CDEO, CCC, CEMC, CPB, CFPC, COBGC, senior documentation specialist at St. Joseph’s/Candler Medical Group. Coders should be proficient in medical terminology and anatomy to be sure they are selecting the correct ICD-10-CM code.

Bradycardia defined: Usually, an adult at rest will have a heartbeat of 60 to 100 beats per minute (bpm). A patient with bradycardia will have a heartbeat of less than 60 bpm; however, there are exceptions to this, according to the American Heart Association (AHA). For example, a resting heart rate between 40 and 60 beats a minute is quite common during sleep and in some people, particularly healthy young adults and trained athletes.

Expert Catherine Brink, BS, CPC, CMM, president of Healthcare Resource Management in Spring Lake, New Jersey, offers insights regarding common coding challenges you may encounter when reporting arrhythmias such as bradycardia and other cardiovascular conditions.

“Always code from the medical documentation by the provider. If the medical record diagnosis is hypotension, then that should be the correct code rather than bradycardia, which is a heart rate below 60 bpm,” says Brink. “If there are underlying medical conditions documented, they should be coded as well. The sequencing of diagnosis codes depends on the primary medical condition, for example, bradycardia, and the underlying medical conditions, comorbidities, or heart disease that affects the bradycardia.”

To successfully report bradycardia, you must understand the definition of bradycardia versus hypotension (low blood pressure) and be able to read the medical documentation for any underlying medical conditions and comorbidities, Brink reiterates.

Tip 2: Rely on R00.1 for Sinus Bradycardia

Sinus bradycardia is a type of arrhythmia that originates from the sinoatrial (SA) node, the heart’s natural pacemaker. This condition is most common in patients who exercise regularly or are over age 65.

Report R00.1 (Bradycardia, unspecified) for sinus bradycardia. Although the code description points to “unspecified bradycardia,” if you look in the ICD-10-CM code book, you will see that code R00.1 also includes the following conditions:

• Sinoatrial bradycardia
• Sinus bradycardia
• Slow heartbeat
• Vagal bradycardia

Don’t miss: According to 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: Understand Sick Sinus Syndrome Coding Specifics

Sick sinus syndrome (SSS) is another type of bradycardia you may see in the documentation. Report I49.5 (Sick sinus syndrome) for this condition, Hodge says.

Don’t miss: 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).

Normally, the heartbeat starts in an area in the top right chamber of the heart (atrium), says Rebecca Sanzone, CPC, CPMA, quality assurance specialist at St. Vincent Medical Group/Ascension Health and coding consultant at the American College of Cardiology. This area is made up of pacemaker cells and goes by a few names: the sinoatrial node, sinus node, or SA node. Its role is to keep the heartbeat steady and regular.

Sick sinus syndrome refers to a collection of disorders marked by the heart’s inability to perform its pacemaking function, according to Sanzone. In patients with SSS, the SA node is damaged and unable to regulate the speed of heartbeats. Predominantly affecting older adults, sick sinus syndrome comprises various arrhythmias, including bradyarrhythmia with or without accompanying tachyarrhythmias.

You may not come across SSS as often as other arrhythmias, but it’s not rare, Sanzone indicates. In fact, it is the most common reason people need to have an artificial pacemaker implanted.

Included condition: Code I49.5 also includes tachycardia-bradycardia syndrome. This condition occurs when the patient’s heart sometimes beats too quickly (tachycardia) and sometimes beats too slowly (bradycardia). Patients may develop tachy-brady syndrome if they’ve been diagnosed with SSS or atrial fibrillation (AFib), an irregular and often very rapid heart rhythm.

Patients with tachycardia-bradycardia syndrome may have palpitations and lightheadedness. They may also pass out and be at a higher risk of stroke. Cardiologists may insert a pacemaker for patients with tachycardia-bradycardia syndrome to keep the heart from beating too slowly or too fast. Or they may prescribe medication to slow the heart rate down.