A patient presented with palpitations and presyncopal symptoms, which he experienced while going from a sitting to standing position. The provider diagnosed sinus bradycardia and multiple premature ventricular contractions. Code I49.3, Ventricular premature depolarization, cannot be assigned with code R00.1, Bradycardia, unspecified, based on the Excludes1 note at category I49-, Other cardiac arrhythmias. However, there is an Excludes 2 note at category R00-, Abnormalities of heart beat, which allows the reporting of codes in that category with specified arrhythmias (I47-I49). Should codes for sinus bradycardia and premature ventricular contractions be assigned together?
Assign both code I49.3, Ventricular premature depolarization, and code R00.1, Bradycardia, unspecified. Although there is an Excludes1 note at category I49-, Other cardiac arrhythmias, for sinus bradycardia, these are distinct (unrelated) cardiac conditions, which can exist independently. In order to convey the complete clinical picture, code both conditions.