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November 22, 2010

Coding for Heart Arrhythmias
For The Record
Vol. 22 No. 21 P. 28

Heart rhythm problems occur when the electrical impulses in the heart don’t function properly, causing the heart to beat too fast, too slow, or irregularly.

A heart arrhythmia may not cause any noticeable symptoms and may be identified only during a routine medical exam. If symptoms are present, they may include tachycardia (fast heartbeat), bradycardia (slow heartbeat), palpitations or skipped beats, fluttering in chest, chest pain or discomfort, shortness of breath, lightheadedness, dizziness, weakness or fatigue, syncope or near syncope, paleness, or sweating.

Arrhythmia Types
The following are some common types of arrhythmia:

• Atrial fibrillation (427.31) is a fast and chaotic heartbeat that becomes uncoordinated. Instead of the atria and ventricles producing a single contraction, the atria beats so rapidly that it fibrillates. Atrial fibrillation may be considered paroxysmal (lasting for a short time) or an ongoing, chronic condition.

• Atrial flutter (427.32) is caused by one or more rapid circuits in the atrium. It is more organized and regular than atrial fibrillation and often becomes atrial fibrillation or may be present with such.

• Supraventricular tachycardia (SVT) is a burst of rapid heartbeats occurring above the ventricles. If the SVT is documented as paroxysmal, then code 427.0 is assigned. However, if only SVT is documented, then code 427.89 is assigned. Paroxysmal means the arrhythmia begins and ends suddenly. If the documentation is unclear, the physician may need to be queried for clarification.

• Ventricular tachycardia (427.1) is abnormal electrical impulses that originate in the ventricles. It may be documented as nonsustained (lasting for less than 30 seconds) or sustained. If not treated promptly, sustained ventricular tachycardia may progress into ventricular fibrillation.

• Ventricular fibrillation (427.41) is rapid, chaotic electrical impulses causing the ventricles to fibrillate ineffectively so they fail to pump blood.

• Ventricular flutter (427.42) is rapid contractions of the ventricles of the heart. Without treatment, ventricular flutter may progress to ventricular fibrillation.

• Premature beats (427.60 to 427.69) occurs when there is an extra heartbeat between two normal beats.

• Sick sinus syndrome (427.81) occurs when the sinus node doesn’t send proper impulses, causing the heart rate to be too slow or too fast. This condition may also be documented as tachy-brady syndrome.

Most arrhythmias are triggered by some form of existing heart-related problem. Typically, if a patient has a normal, healthy heart, it is unlikely they will experience an arrhythmia. Some common causes of arrhythmias include myocardial infarction (scarring of heart tissue), coronary artery disease, high blood pressure, the healing process from heart surgery, diabetes, electrolyte imbalances, hyperthyroidism, smoking, excessive alcohol or caffeine use, drug abuse, stress, medications, and dietary or herbal supplements.

The following studies may be performed to aid in diagnosing arrhythmia: electrocardiogram, Holter monitor, event monitor, echocardiogram, cardiac CT, MRI, stress test, tilt table test, and electrophysiologic study.

Treatment will depend on whether the arrhythmia is causing significant symptoms or increasing a patient’s risk of a more serious arrhythmia or complication. Treatment may include antiarrhythmic medications, anticoagulant or antiplatelet therapy, cardioversion, ablation therapy, a pacemaker, an implantable cardioverter-defibrillator, and/or the Maze procedure.

Coding and sequencing for heart arrhythmias are dependent on physician documentation in the medical record and application of the Official Coding Guidelines for inpatient care. Also, use specific AHA Coding Clinic for ICD-9-CM and American Medical Association CPT Assistant references to ensure complete and accurate coding.

— This information was prepared by Audrey Howard, RHIA, of 3M Consulting Services. 3M Consulting Services is a business of 3M Health Information Systems, a supplier of coding and classification systems to more than 5,000 healthcare providers. The company and its representatives do not assume any responsibility for reimbursement decisions or claims denials made by providers or payers as the result of the misuse of this coding information. More information about 3M Health Information Systems is available at www.3mhis.com or by calling 800-367-2447.