Current RMA Instruments

Changes from previous Instruments

SOP Bulletin 229

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

Heart block is a disorder involving the electrical signals in the heart. The signals from the atria to the ventricles, which control how the heart beats, are delayed or interupted at one of several sites along an anatomical pathway.  The severity of the condition varies with the particular site and type of block.  Presentations can range from asymptomatic through to severe symptoms requiring emergency treatment.

Confirming the diagnosis

The diagnosis is made from an electrocardiogram - either as a one off procedure or with ongoing (Holter) monitoring over a period of time.  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*
• 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).  Third degree heart block can present as a cardiac arrest.  Clinical onset will often date from the time of an electrocardiogram (ECG), particularly 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 with 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.