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Understand and correctly apply the Long QT Syndrome code

HIM Connection, January 13, 2006

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As benign as its name appears, you must pay special attention to the Long QT Syndrome code (426.82). Cardiology has made tremendous advances regarding sudden cardiac arrest and studies have shown that patients with significant risk factors for this potentially fatal situation can live longer with prophylactic implantation of a defibrillator.

Defibrillators have been a classic indication for ventricular tachycardia/fibrillation. At one time, that was the only indication for Medicare payment for defibrillator insertion.

New indications were added in 1999 and 2003, and you can find the most recent indications from Medicare to permit embedding of defibrillators in the March 8, 2005, Transmittal 497. They include

• patients with ischemic dilated cardiomyopathy, documented prior myocardial infarction (MI), NYHA Class II and III heart failure, and measured LVEF < = 35%
• patients with non-ischemic dilated cardiomyopathy (NIDCM) > 9 months, NYHA Class II and III heart failure, and measured LVEF < = 35%
• patients who meet all current Centers for Medicare & Medicaid Services (CMS) coverage requirements for a cardiac resynchronization therapy device and have NYHA Class IV heart failure
• patients with NIDCM > 3 months, NYHA Class II and III heart failure, and measured LVEF < = 35%

We have become used to having the physicians or physician extenders (i.e., nurse practitioners or physician's assistants) check boxes on the form that came with the transmittal. Doing so permitted them to demonstrate that each individual case fits into one of the above four criteria. However, we will never reach the correct DRG without realizing that only one code truly demonstrates retrospectively that the patient had this condition-428.22 (Chronic Systolic Heart Failure or Heart Failure due to Chronic Systolic Dysfunction). If physicians don't provide the documentation, they're not treating it.

Let's talk about sudden cardiac arrest (SCA) so we can understand the concept of defibrillator insertion for conditions other than already-occurring ventricular arrhythmias.

SCA is the sudden, abrupt loss of heart function generally caused by rapid, irregular rhythm of the ventricles (ventricular tachycardia [VT] or ventricular fibrillation [VF]). These arrhythmias result in quivering ventricles that cannot pump blood to the body. Loss of consciousness and pulse follow within seconds.

In approximately 94%-95% of cases, SCA is fatal, leading to sudden cardiac death. Because it is an electrical conduction problem, SCA is not the same as a heart attack (myocardial infarction [MI]), which is caused by a blocked vessel that leads to loss of blood supply to a portion of the heart muscle.

SCA causes more fatalities each year than stroke, lung cancer, breast cancers, and AIDS combined.

Editor's note: This article was adapted from The 2006 ICD-9-CM Training Kit.

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