Health Information Management

Tip of the Week: Report atrioventricular blocks based on the degree of the block

APCs Insider, November 30, 2007

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To code an AV block, report codes based on the degree of the block. The AV block ICD-9 codes range from 426.10 to 426.13:

  • 426.10-AV block, unspecified.
  • 426.11-First degree AV block. This is characterized by a prolonged PR interval (the time it takes for the impulse to travel from the atria to the ventricles) of one-twentieth of a second. This condition does not generally require treatment because most AV blocks are asymptomatic. First-degree AV blocks can be caused by the use of certain drugs, such as Digoxin and beta blockers.
  • 426.12 and 426.13-Second-degree AV block (Mobitz Type I and II).
  • 426.0-Complete AV block (third degree).

The AMA subdivides second-degree AV blocks into Mobitz Type I and II:

  • Mobitz Type I-Characterized by progressive prolongation of the PR interval until a P-wave is blocked and the cycle is repeated. This condition does not generally require treatment unless the patient exhibits severe symptoms. This is characterized by atrial impulses that do not reach the ventricles at all. This condition necessitates intervention of atropine, transcutaneous pacing, catecholamine infusions (Dopamine or Epinephrine), and transvenous pacemaker.
  • Mobitz Type II-Characterized by a constant PR interval preceding a blocked P-wave. It is usually associated with an organic lesion in the conduction pathway. This type of block is rarely associated with drug effects and can progress to a complete AV block. Along with conduction disorders, there are also codes specifically for cardiac dysrhythmias. Examples of dysrhythmias include conditions such as tachycardia and sick sinus syndrome.

(The above tip appeared in the December issue of Briefings on APCs).

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