Cardiology Coding Alert

SSS and bradycardia options take the place of sinoatrial node dysfunction code.

A quick look may show you how ICD-10 divvies up sinoatrial node dysfunction code 427.81 into two distinct codes. But you’ll need to dig a little deeper to see how 427.81’s “includes” list gets assigned under the new code set. 

ICD-9-CM Code

• 427.81, Sinoatrial node dysfunction
  

ICD-10-CM Code

• I49.5, Sick sinus syndrome
• R00.1, Bradycardia, unspecified

Sinoatrial node dysfunction refers to a number of conditions that cause inappropriate atrial rates. Sick sinus syndrome (SSS) is a type of bradycardia (slow heart rate) where the sinoatrial node (aka sinus node) isn’t working properly.

ICD-9 coding rules: Code 427.81 applies to a variety of diagnoses, including:

• Sinus bradycardia, persistent
• Sinus bradycardia, severe
• Syndrome, sick sinus
• Syndrome, tachycardia-bradycardia.

But you should assign 427.89 for sinus bradycardia NOS.

ICD-10 changes: ICD-10 puts “sick sinus syndrome” in the spotlight, giving it its own code at I49.5. The code is also appropriate for tachycardia-bradycardia syndrome.

If the documentation shows sinoatrial bradycardia, sinus bradycardia, slow heartbeat, or vagal bradycardia, you’ll use R00.1 instead.

Documentation: Let clinicians know that if the patient has sick sinus syndrome or tachycardia-bradycardia syndrome, documenting those specific terms is crucial to helping you choose the best code. Otherwise, you may be limited to choosing unspecified code R00.1. Payers may see an unspecified code as weak proof of medical necessity.

Coder tips: If you choose I49.5, you should “code first” cardiac arrhythmia complicating:

• Abortion or ectopic or molar pregnancy (O00-O07, O08.8)
• Obstetric surgery and procedures (O75.4).

And note that before you choose R00.1, you should check the excludes note for abnormalities originating in the perinatal period (P29.1-, Neonatal cardiac dysrhythmia) and specified arrhythmias (I47-I49).

Remember: Congress delayed the ICD-10 compliance date of Oct. 1, 2014, until at least Oct. 1, 2015. CMS has proposed Oct. 1, 2015, as the new compliance date. When ICD-10-CM goes into effect, 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.