Cardiology Coding Alert

Reviewing index entries helps to solve the bifascicular puzzle.

When ICD-10-CM becomes effective on Oct. 1, 2014, you’ll have fewer options for reporting bifascicular blocks. Here are the details you’ll need to properly apply the new code.

ICD-9-CM codes:

• 426.51, Right bundle branch block and left posterior fascicular block
  
• 426.52, Right bundle branch block and left anterior fascicular block
  
• 426.53, Other bilateral bundle branch block
  

ICD-10 code:

• I45.2, Bifascicular block

After the heart’s electrical impulse passes through the AV node (between the atria and ventricles), the impulse passes along the bundle of His, which divides into a right bundle and a left bundle. The left bundle branches into a left posterior fascicle and a left anterior fascicle. Bifascicular block means the heart shows impaired conduction in two fascicles of the right and left bundles.

ICD-9 coding rules: Your choice between 426.51 and 426.52 depends on whether the patient has a left posterior or left anterior fascicular block in addition to right bundle branch block (RBBB). For other bilateral bundle branch blocks, including bifascicular block NOS, bilateral bundle branch block NOS, and right bundle branch with left bundle branch block (incomplete) (main stem), you should use 426.53.

ICD-10 changes: ICD-10 includes all bifascicular blocks under I45.2. Terms indexed to I45.2 include bilateral bundle-branch block, incomplete left bundle-branch block with right bundle branch block, and right bundle branch block with left fascicular block.

Documentation: The physician will need to be sure to indicate that the block is bifascicular, as that is the key indicator for I45.2.

Coder tips: As you adjust to the new ICD-10 codes, remember to look at the codes surrounding your initial code choice. This will help you determine what distinguishes similar codes from one another. For example, near I45.2, you’ll see codes specific to atrioventricular blocks, left bundle-branch blocks, right bundle-branch blocks, and trifascicular blocks, as well as nonspecific intraventricular blocks and other specified blocks.

Remember: CMS has finalized the ICD-10 compliance date of Oct. 1, 2014. When ICD-10 is implemented, you should apply the code set and official guidelines in effect for the date of service reported. Learn more at www.cms.gov/ICD10/ and www.cdc.gov/nchs/icd/icd10cm.htm#10update.