Accelerated Idioventricular Rhythm

This installment of “In the kNOW” is going to cover accelerated idioventricular rhythm (AIVR). This condition presents some difficulty when attempting to assign the appropriate ICD-10-CM code. The Alphabetic Index has only one subentry under Rhythm for idioventricular and the code to which we are directed, I44.2 Atrioventricular block, complete, does not appear to be correct. As Coding Clinic is fond of reminding us, when this disconnect occurs, further research is necessary to ensure the code assigned is accurate. In this case, we should begin by understanding more about AIVR.

Accelerated idioventricular rhythm is a type of arrhythmia where the ventricles are beating faster than would be considered normal sinus rhythm (NSR), but not to the degree where ventricular tachycardia criteria are met. On the other hand, idioventricular rhythm is when the ventricles are beating in a slow rhythm of generally less than 50 beats per minute. When studying an EKG, there will be a lack of P waves and wide QRS complexes.

This graphic shows EKG examples for both of these arrhythmias along with ventricular tachycardia.

Now that we know there is definitely a difference between AIVR and idioventricular rhythm, we can disregard the I44.2 code. Our arrhythmia is specified but does not have its own code, so assign I49.8 for Other specified cardiac arrhythmias. 

Now you are In the kNOW!!

About the Author

Dianna Foley, RHIA, CCS, CDIP, CHPS, has 25 years of HIM experience. She earned her bachelor’s degree from the University of Cincinnati and holds RHIA, CHPS, CDIP, and CCS certifications from AHIMA. Dianna’s an AHIMA-approved ICD-10-CM/PCS trainer, an AHIMA-published author, a participant in AHIMA credential item writing and exam development, and served on the AHIMA Nominating Committee. Dianna has held various HIM positions and is now an independent coding consultant. She previously served as a program director for Medical Coding and HIT. She presents on coding topics at the national, state, and regional levels and serves as OHIMA’s Education Coordinator.