Cardiac arrest. A phrase that is not all that uncommon to coding professionals. This month, “In the kNOW” will share information on the proper coding for cardiac arrest.
A cardiac arrest is not the same as a myocardial infarction. Electrical disturbances of the heart are generally the cause of cardiac arrests. ICD-10-CM has three possible codes that coding professionals can choose from to capture a cardiac arrest:
I46.2 Cardiac arrest due to underlying cardiac condition
I46.8 Cardiac arrest due to other underlying condition
I46.9 Cardiac arrest, cause unspecified
(All of the above codes are considered MCCs.)
I46.2 and I46.8 have “Code first” notes indicating that the underlying condition must be sequenced first. An ICD-9-CM Coding Clinic, First Quarter 2013, indicates that when the underlying cause of the cardiac arrest is known, it is coded and sequenced first, followed by the cardiac arrest code. This is true regardless of whether the patient is successfully resuscitated or not.
That same issue of Coding Clinic addresses an instance when a patient is admitted in cardiac arrest and expires prior to identification of the underlying condition. In that circumstance, it is appropriate to code the cardiac arrest and sequence it as the principal or first-listed diagnosis depending on the circumstances of the admission.
The most recent copy of ICD-10-CM/PCS Coding Clinic, First Quarter 2024 addressed the proper coding for a cardiac arrest that occurred at home with resuscitation achieved prior to the patient’s arrival at the ER. Is this considered a personal history of a cardiac arrest and coded to Z86.74? The response indicated that because the patient continued to receive treatment, code I46.2 should be assigned. This would be true no matter where the arrest happened or if the patient was revived or not. The Z86.74 would only be assigned when it meets guideline I.C.21.c.4-“Personal history codes explain a patient’s past medical condition that no longer exists and is not receiving any treatment, but that has the potential for recurrence, and therefore may require continued monitoring.”
When a patient has a cardiac arrest following surgery, two different Coding Clinics, one from Second Quarter 2000 and one from First Quarter 2013, both indicate that the appropriate complication code is assigned with the cardiac arrest code sequenced after the complication code.
When cardiogenic shock and cardiac arrest are both documented, how should these be coded? ICD-10-CM/PCS Coding Clinic, Third Quarter ICD-10 2020 stated to only code the definitive diagnosis of cardiac arrest following the Excludes1 note for the cardiogenic shock. However, in 2021, that Excludes1 note changed to an Excludes2 note making it possible to assign both codes in some instances.
What about documentation of pulseless electrical activity (PEA), should this be coded as a cardiac arrest? Pulseless electrical activity can be caused by conditions such as hypovolemia or hypoxic respiratory failure. Since PEA indicates that the patient does not have a pulse, but there is electrical activity on a monitor, an ICD-9-CM Coding Clinic from First Quarter 2013 stated that this is considered a pulseless cardiac arrest. Therefore, it is appropriate to code this as a cardiac arrest.
What about documentation of the term asystole? An ICD-10-CM/PCS Coding Clinic from the Second Quarter 2019 addresses what coding professionals are to do if there is documentation of asystole on an electrocardiogram report. The question to Coding Clinic was concerning the appropriateness of assigning cardiac arrest if asystole alone is documented since when the Alphabetic Index is reviewed at asystole, there is a “see” note for arrest, cardiac. The response was no, unless there is documentation of the cardiac arrest, when asystole is noted along with a spontaneous conversion, code the underlying condition that caused the asystole.
Now you are In the kNOW!!
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