Wiki EKG / ECG Dx Coding

[SA91]

Good day all!

I am still a apprentice coder and would appreciate some advise/input on assigning Dx for EKG's (results).

I have two coders (one audited my encounters) that we need to assign Dx for definitive results. Would anyone have a list of definitive Dx for these results or can advise (I have my own but some are little harder to determine) for example Prolonged QT is considered not definitive but long QT is (this is what one coder told me? I have assigned I45.81 to Prolonged QT now this needs changed?) I have another example of where the auditor told me to assign R94.31 according to the following result : Sinus rhythm Borderline T abnormalities, inferior leads (I went with what is on the order with was R42); the other coder agreed that that result was not definitive.

I just want to make sure I am understanding these results and orders.

I would greatly appreciate any feedback !

Kind regards,
SA91.

 

[thomas7331]

'Prolonged QT', per the ICD-10 alphabetic index, is classified to R94.31. I would code 'long QT' the same way as I don't see any substantial difference in the two. But I45.81 is for 'long QT syndrome' which is a different thing so in the absence of a documented diagnosis of the 'syndrome', I would not use that code.

I'd agree with the auditor on using R94.31 for a borderline abnormality. Per the ICD-10 guidelines, "borderline conditions are not uncertain diagnoses", so should be coded as definitive, so the coding of an abnormal EKG is appropriate.

That said, I do recommend caution using results from the interpretation in coding diagnostic tests since the treating provider ultimately may or may not agree that the result is clinically significant. If there is any question, it's best to use the diagnosis from the order as the primary reason for the procedure. But your auditors should be sharing their audit guidelines with you so that you have a clear understanding of what their expectations are, since different organizations and facilities may handle these situations differently.

 

[SA91]

'Prolonged QT', per the ICD-10 alphabetic index, is classified to R94.31. I would code 'long QT' the same way as I don't see any substantial difference in the two. But I45.81 is for 'long QT syndrome' which is a different thing so in the absence of a documented diagnosis of the 'syndrome', I would not use that code.

I'd agree with the auditor on using R94.31 for a borderline abnormality. Per the ICD-10 guidelines, "borderline conditions are not uncertain diagnoses", so should be coded as definitive, so the coding of an abnormal EKG is appropriate.

That said, I do recommend caution using results from the interpretation in coding diagnostic tests since the treating provider ultimately may or may not agree that the result is clinically significant. If there is any question, it's best to use the diagnosis from the order as the primary reason for the procedure. But your auditors should be sharing their audit guidelines with you so that you have a clear understanding of what their expectations are, since different organizations and facilities may handle these situations differently.

Hi there!

Thank you so much for advising and explaining this truly appreciate it and it makes so much more sense!

Hopefully when our manager returns there would be more of clarity of what is really expected. I am not sure if our auditor or leads are swamped with work but I feel like not a lot of effort was put in to explain this a little clearer (the coder II also got this wrong as this is what she has kind of trained me to do).

As Coder II explained on the 'borderline Dx's - Borderline T-wave is not a definitive dx either' (anything borderline we go with the order).

Kind regards,
SA91.