Cardiac arrest. Two little words with huge implications for a patient. Cardiac arrest is the term used when the heart suddenly stops beating. It can lead to death or permanent disability if not treated immediately. For our “In the kNOW” discussion this month, we will cover this topic in more depth.
First, let’s note that a cardiac arrest is different than a heart attack. Although these terms might be used interchangeably, they are not the same. A heart attack occurs when there is a blockage in a patient’s coronary artery(ies). A heart attack may change the heart’s electrical signals and lead to cardiac arrest. Cardiac arrest occurs as the result of arrhythmia, including ventricular fibrillation, cardiomyopathy, or coronary artery disease (CAD). Arrhythmias are abnormal heart beats due to an issue with the electrical signals in the heart. Ventricular fibrillation occurs when the ventricle beats rapidly causing a malfunction of the ventricular pumping. Cardiomyopathy is a thickening of the heart muscle which results in abnormal heart contractions. CAD causes reduced blood flow through the coronary vessels due to blockages in the arteries. Untreated CAD can lead to arrhythmias or heart failure which, in turn, can produce a cardiac arrest.
Treatment for a cardiac arrest includes cardiopulmonary resuscitation (CPR) which is usually the first type of treatment rendered until the patient can receive an electrical shock via a defibrillator. The goal of CPR is to use chest compressions to facilitate movement of oxygenated blood to the body’s organs hopefully preventing or minimizing organ damage. Defibrillation is normally performed by trained providers or first responders. This device sends a shock to the heart muscle in hopes of restoring a normal heartbeat.
In ICD-10-CM, codes for a cardiac arrest are found in the I46 category. There are three main choices when coding a cardiac arrest which are as follows:
I46.2 Cardiac arrest due to underlying cardiac condition
I46.8 Cardiac arrest due to other underlying condition
I46.9 Cardiac arrest, cause unspecified
There are codes for cardiac arrests that occur in other specific circumstances such as following a surgical procedure (I97.12x) or complicating a delivery (O75.4). When a patient has had a previous cardiac arrest with successful resuscitation, code Z86.74 may be assigned.
Let’s look at some Coding Clinic (CC) information that will help coding professionals assign the appropriate cardiac arrest code. First, a 2013 CC from the first quarter tells us that it is acceptable to assign cardiac arrest when pulseless electrical activity (PEA) is documented without mention of cardiac arrest.
That same issue of CC states that when a cardiac arrest is the result of a cardiac condition such as a paroxysmal ventricular tachycardia, the underlying cause should be sequenced first, followed by a code for the cardiac arrest. Another piece of advice from that particular CC, is that cardiac arrest may be the principal diagnosis should the underlying cause of the arrest remain unknown.
A second quarter CC from 2019 does remind coding professionals that they should not assign cardiac arrest based on documentation in an electrocardiogram that there is asystole with spontaneous recovery of sinus rhythm.
Most recently, in a first quarter 2024 CC, the use of Z86.74 for personal history of cardiac arrest was addressed. In a scenario where a patient was in cardiac arrest at home and resuscitated by emergency medical services before arriving at the hospital, the question was should the personal history code be used or should the cardiac arrest be coded? Using Official Coding Guideline I.C.21.c.4 as the basis for the answer, CC stated that the cardiac arrest would be coded in this situation, and this would be true whether or not the patient was resuscitated. The guideline explains that a personal history code is assigned when the patient no longer has the condition, isn’t receiving any treatment, and doesn’t need any monitoring. In the scenario addressed by CC, the patient required additional monitoring and treatment for the condition so the cardiac arrest is considered a current condition, not a history, even though they were resuscitated.
Now you are In the kNOW!!
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