AHA Coding Clinic® for ICD-9 - 2006 Issue 2; Ask the Editor

Intermittent Complete Heart Block

This patient presented to the emergency department following episodes of syncope. The patient had runs of asystole while on cardiac monitor with loss of consciousness. On the telemetry strips the patient was found to have normal sinus rhythm with periods of complete AV block with ventricular asystole. At the time of consultation the patient was in normal sinus rhythm with an underlying first degree AV block and a second degree type II AV block. Physician’s documentation states that the patient goes in and out of second degree heart block. The placement of a permanent pacemaker was discussed but the patient refused. What is the correct code assignment for intermittent complete heart block when a patient goes in and out of second degree heart block type II, and has an underlying first degree heart block? Is it appropriate to assign only code 426.0, AV block complete, or should code 426.12, Mobitz (type) II AV block, and code 426.11, First degree AV block, be assigned as additional codes? ...

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