bennieyoung
Guru
I would like an opinion on if I should have used I44.2 as a diagnosis for this...
The slow pathway was identified with 3D electroanatomical mapping as well as identification of slow pathway potentials during sinus rhythm in the usual location. Ablation anterior to the CS os was performed. Junctional acceleration was noted. The patient quickly developed A-V dissociation with complete heart block. This persisted for several seconds with continued ventricular pacing at that time. AV nodal conduction gradually recovered. Further ablation targeting the slow pathway anterior to the coronary sinus os was commenced at this time. The patient quickly developed complete heart block with need for continued ventricular pacing for several seconds. AV nodal conduction recovered. Atrial programmed stimulation on isoproterenol was performed and SVT could no longer be induced.
My auditor says no, that this was transient as the conduction was recovered. I disagreed with this explanation
... Some coding resources indicate that complete AV Block resulting from an AV nodal ablation should be coded with I44.2. Coding resources confirm that I44.2 is the correct diagnosis for a complete heart block resulting from AV node ablation. AV node ablation is performed to deliberately create a complete heart block in order to disrupt abnormal electrical pathways that cause certain arrhythmias like chronic afib. The code description for the ablation specifies that it is for the creation of complete heart block. The resulting complete heart block is the desired therapeutic effect, not accidental complication. I believe that I44.2 is the correct diagnosis to use. You code the underlying condition first and I44.2 is the medical reason for the pacemaker so it would be listed as primary even if the patients conduction has recovered, the pacemaker was still necessary.
My auditor wasn't swayed by this. Am I wrong to have used I44.2? If not, is there anything I can add to my argument that I haven't used?
Thanks so much for any help you can offer with this.
The slow pathway was identified with 3D electroanatomical mapping as well as identification of slow pathway potentials during sinus rhythm in the usual location. Ablation anterior to the CS os was performed. Junctional acceleration was noted. The patient quickly developed A-V dissociation with complete heart block. This persisted for several seconds with continued ventricular pacing at that time. AV nodal conduction gradually recovered. Further ablation targeting the slow pathway anterior to the coronary sinus os was commenced at this time. The patient quickly developed complete heart block with need for continued ventricular pacing for several seconds. AV nodal conduction recovered. Atrial programmed stimulation on isoproterenol was performed and SVT could no longer be induced.
My auditor says no, that this was transient as the conduction was recovered. I disagreed with this explanation
... Some coding resources indicate that complete AV Block resulting from an AV nodal ablation should be coded with I44.2. Coding resources confirm that I44.2 is the correct diagnosis for a complete heart block resulting from AV node ablation. AV node ablation is performed to deliberately create a complete heart block in order to disrupt abnormal electrical pathways that cause certain arrhythmias like chronic afib. The code description for the ablation specifies that it is for the creation of complete heart block. The resulting complete heart block is the desired therapeutic effect, not accidental complication. I believe that I44.2 is the correct diagnosis to use. You code the underlying condition first and I44.2 is the medical reason for the pacemaker so it would be listed as primary even if the patients conduction has recovered, the pacemaker was still necessary.
My auditor wasn't swayed by this. Am I wrong to have used I44.2? If not, is there anything I can add to my argument that I haven't used?
Thanks so much for any help you can offer with this.