Cardiology Coding Alert

Hint: Report I47.1 for supraventricular tachycardia.

Most coders probably agree that reporting ICD-10-CM codes can be very tricky because you have so many different choices based on specificity. You must read the medical documentation clearly to ensure that you are catching all the different details that would point you towards the correct code. Reporting for tachycardia, an abnormally fast heartbeat, is no exception to this rule.

Answer the following FAQs to make sure your tachycardia coding stays on rhythm.

Mark Down Tachycardia Definition

FAQ 1: What is tachycardia?

Answer: Tachycardia occurs when a patient’s heart beats too quickly. Usually, tachycardia is described as a heart rate of over 100 beats a minute at rest.

Tachycardia sometimes has other symptoms as well, such as dizziness, shortness of breath, and chest pain, says Rebecca Sanzone, CPC, CPMA, compliance administrator at St. Vincent Medical Group/Ascension Health in Indianapolis, Indiana. Common testing for tachycardia includes electrocardiograms (EKGs) and stress tests.

Discover Different Types of Tachycardia

FAQ 2: What are the different types of tachycardia?

Answer: There are many different types of tachycardia, according to Sanzone. For example, sinus tachycardia refers to a typical increase in the patient’s heart rate often caused by exercise or stress.

Many types of irregular heart rhythms, or arrhythmias, can cause tachycardia. Common types of tachycardia caused by arrhythmias include the following, per Sanzone:

• Atrial fibrillation (A-fib)
• Ventricular fibrillation (V-fib)
• Atrial flutter
• Ventricular tachycardia (VT)
• Supraventricular tachycardia (SVT)

Code I47.2 Covers Sustained, Non-Sustained Ventricular Tachycardia

FAQ 3: What ICD-10-CM code should you report for ventricular tachycardia?

Answer: You should report I47.2 for ventricular tachycardia, Sanzone says.

Ventricular tachycardia is a fast heart rhythm that starts in the lower chambers of the heart. Code I47.2 covers sustained ventricular tachycardia, non-sustained ventricular tachycardia, and Torsades de Pointes (TdP).

Note Multiple Included Conditions for I47.1

FAQ 4: Which ICD-10-CM code should I report for supraventricular tachycardia?

Answer: You should report I47.1 (Supraventricular tachycardia) for supraventricular tachycardia. Supraventricular tachycardia refers to a faster than normal heart rate that originates in the atria or the atrioventricular node.

Included conditions for code I47.1 include:

• Atrial (paroxysmal) tachycardia
• Atrioventricular [AV] (paroxysmal) tachycardia
• Atrioventricular re-entrant (nodal) tachycardia [AVNRT] [AVRT]
• Junctional (paroxysmal) tachycardia
• Nodal (paroxysmal) tachycardia

Code first note: A code first note instructs you to sequence tachycardia complicating the following conditions first, followed by I47.1:

• O00.0 (Abdominal pregnancy) through O07 (Failed attempted termination of pregnancy)
• O08.8 (Other complications following an ectopic and molar pregnancy)
• O75.4 (Other complications of obstetric surgery and procedures)

Differentiate Between Atrial Fib and Atrial Flutter

FAQ 5: What is the difference between atrial fibrillation and atrial flutter? Which ICD-10-CM codes should I report for each of these conditions?

Atrial fibrillation: With atrial fibrillation, the atria quiver or fibrillate rather than beating normally. Your ICD-10 options for atrial fibrillation are as follows:

• I48.0 (Paroxysmal atrial fibrillation)
• I48.11 (Longstanding persistent atrial fibrillation)
• I48.19 (Other persistent atrial fibrillation)
• I48.20 (Chronic atrial fibrillation, unspecified)
• I48.21 (Permanent atrial fibrillation)
• I48.91 (Unspecified atrial fibrillation)

Paroxysmal atrial fibrillation is described as occurring spontaneously and resolving spontaneously, usually within 48 hours, and can be recurrent, says Robin Peterson, CPC, CPMA, manager of professional coding services, Pinnacle Integrated Coding Solutions, LLC. Persistent atrial fibrillation is defined as atrial fibrillation that does not terminate within seven days; whereas longstanding persistent atrial fibrillation is defined as persistent and continuous atrial fibrillation, which lasts longer than a year.

“According to AHA ICD-10 Coding Clinic Vol. 6, No. 4, ‘the term chronic atrial fibrillation could mean persistent, longstanding persistent, or permanent, and the more specific term is preferred over the non-specific term ‘chronic,’” Peterson says. “Also, the term ‘chronic persistent atrial fibrillation’ has no widely accepted clinical definition or meaning and should be coded as ‘other persistent atrial fibrillation.’”

Atrial flutter: With atrial flutter, rapidly fired signals make the muscles in the atria contract quickly, which leads to a fast, steady heartbeat. Your ICD-10 options for atrial flutter are as follows:

• I48.3 (Typical atrial flutter)
• I48.4 (Atypical atrial flutter)
• I48.92 (Unspecified atrial flutter)

Conquer Common Tachycardia Coding Challenges

FAQ 6: I’m new to cardiology, and I’m having a difficult time with understanding how to correctly report tachycardia. Do you have any advice to help me?

Answer: Many coders just report tachycardia with the unspecified code R00.0 (Tachycardia, unspecified), says Catherine Brink, BS, CPC, CMM, president of Healthcare Resource Management in Spring Lake, New Jersey. “If that is what is documented in the medical record, then it is correct. However, it is important to note that ‘unspecified’ codes may not support the medical necessity of the service rendered.”

Brink added that coders should educate their providers about the importance of specifying the specific type of tachycardia the patient has in the medical documentation.

“Of course, if the provider cannot specify the exact type of tachycardia, then the documentation would be ‘unspecified tachycardia — R00.0,’” Brink added.

Sanzone agrees that knowing the specific type of tachycardia is key to correct coding.

You must know if the type of tachycardia has been determined by capture on a test, such as an EKG or stress test, Sanzone said. “You do not want to code someone with SVT or VT if they are just having sinus tachycardia. You need specifics to code properly.”