Current RMA Instruments

Changes from previous Instruments

SOP Bulletin 171

ICD Coding

• ICD-9-CM Codes: 426.0-5,426.9
• ICD-10-AM Codes: I44, I45.0, I45.1, I45.2, I45.3, I45.4, I45.9

Brief description

This is a cardiac condition where disease or injury has interfered with (delayed) the conduction of electrical impulses along the normal electric conduction pathway through the heart, being the atrioventricular node, bundle of His, the left and right bundle branches and the anterior and posterior fascicles.

Confirming the diagnosis

The diagnosis is made from an electrocardiogram.  The diagnosis can be made by a GP.

The relevant medical specialist is a cardiologist.

Additional diagnoses covered by SOP

• Atrioventricular block
• Bifascicular block
• First degree heart block
• Second degree heart block
• Third degree heart block
• Left bundle branch block
• Right bundle branch block
• Mobitz block
• Trifascicular block
• Wenckebach’s block

Conditions excluded from SOP

• Atrial fibrillation; atrial flutter*
• Atrioventricular dissociation^#
• Cardiomyopathy*
• Ischaemic heart disease*
• Pre-excitation syndrome^#
• Sick sinus syndrome*
• Sinoatrial block^#
• Wolff-Parkinson-White syndrome^#

* another SOP applies

# non-SOP condition

Clinical onset

Some types of heart block are asymtpomatic (e.g. first degree atrioventricular block).  Others may present with non-specific symptoms, (e.g. fatigue, shortness of breath, chest pain, feeling faint).  Clinical onset will be at the time of an electrocardiogram (ECG) for asymptomatic presentations, but may be able to be backdated, based on non-specific symptoms, for those types that cause symptoms.

Clinical worsening

Worsening may present with progression to a more serious form of heart block of the development of symptoms in a previously asymptomatic person.  Treatment can range from observation to the need for drug therapy, or the need for a pacemaker.