Cardiology Coding Alert

Find out whether the missing ‘paroxysmal’ affects your coding.

When you switch to ICD-10 in October, you’ll run into some code definitions that are close but not quite the same as their ICD-9 counterparts. This may leave you wondering if you have the proper code for your case. Ventricular tachycardia presents one of these puzzling situations, so here are the facts you need to code with confidence.

ICD-9-CM Code

• 427.1, Paroxysmal ventricular tachycardia

ICD-10-CM Code

• I47.2, Ventricular tachycardia

Ventricular tachycardia is a fast heart rhythm (tachycardia) that starts in the lower chambers of the heart (ventricles).

ICD-9 coding rules: ICD-9 inclusion rules indicate 427.1 is appropriate whether or not the documentation indicates “paroxysmal.” An excludes note under 427.x (Cardiac dysrhythmias) tells you to look elsewhere if the diagnosis is one complicating abortion; ectopic or molar pregnancy; or labor or delivery.

ICD-10 changes: The definition of ICD-10 code I47.2 does not include the term “paroxysmal,” but the range it falls under, I47.-, is defined as “Paroxysmal tachycardia.” Additionally, the ICD-10 index lists I47.2 for these entries, indicating the code is appropriate whether the physician does or doesn’t document “paroxysmal”:

• Tachycardia, ventricular (paroxysmal) (sustained)
• Tachycardia, paroxysmal, ventricular.

As with the ICD-9 range, notes for the ICD-10 range reference proper coding for tachycardia related to obstetric/gynecologic encounters. For ICD-10, you should “code first” tachycardia complicating:

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

Documentation: The ventricular tachycardia documentation that points you to 427.1 now will be sufficient to support choosing I47.2 under ICD-10. You may see the abbreviations VT or v-tach for this diagnosis.

Coder tips: Just like ICD-9 offers 785.0 for unspecified tachycardia, ICD-10 will offer R00.0 for these tachycardia listings:

• NOS
• sinoauricular NOS 
• sinus [sinusal] NOS.

So limit I47.2 to cases where the physician specifies “ventricular.”

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.