Types of Cardiac Devices �

Many cardiac devices are designed to help control An ICD detects an irregular heartbeat and irregular heartbeats. These devices help the ’ automatically delivers a series of pacing pulses electrical system function properly and/or measure or an electrical shock to the to correct the heart rhythm. These devices include pacemakers, heart’s rate and rhythm. ICD devices are surgically implantable cardioverter defibrillators (ICD) and implanted in the chest wall below the collarbone. loop recorders. Cardiac loop recorder-Z95.818 presence of Pacemaker-Z95.0 presence of cardiac pacemaker other cardiac implants & grafts A pacemaker is a device that is implanted under A loop recorder is a wireless cardiac monitor the skin of the chest. It produces electrical pulses which continuously records your heart’s rhythm. to keep the heart beating at a normal rate. A The device is inserted beneath the skin of the pacemaker helps manage heart rhythm disorders upper chest to record the heart’s electrical and/or an . It is implanted in the chest, activitity. The device is implanted through a beneath the collarbone. small incision under the skin in the upper chest. After implantation, the device is checked to Heart assist device-Z95.811 presence of heart see how well the pacemaker is working. The assist device information collected from the device includes A ventricular assist device (VAD) is a mechanical battery life, condition of lead(s) and any pump that is used to support heart function and experienced. blood flow in people who have weakened hearts. Biventricular pacemaker-Z95.0 presence The device takes blood from a lower chamber of the heart and helps pump it to the body and vital of cardiac pacemaker organs, just as a healthy heart would. A VAD may be A biventricular pacemaker works like a conventional used if one or both of the heart’s lower ventricles pacemaker, but uses a third wire to send electrical do not work properly. impulses to the heart to resynchronize the There are 2 types of VAD, left ventricular assist contractions of the heart’s left lower . device (LVAD) and a right ventricular assist device This type of pacemaker is typically used when (RVAD). If both types are used at the same time, ICD-10-CM medications do not relieve symptoms of heart failure. they may be called a biventricular assist device Implantable cardioverter defibrillator(ICD) (BIVAD). However, a BIVAD is not a separate type Coding Cardiac Arrhythmias -Z95.810 Presence of automatic implantable of VAD. **Whilethisdocumentrepresentsourbest cardiac defibrillator An implantable VAD has its pump located inside effortstoprovideaccurateinformationand of the body and its power source located outside usefuladvice,youshouldreferencethecurrent People with heart failure are at risk for ventricular ICD-10-CMmanualforthemostup-to-date arrhythmias. These people may need a combination of the body. A cable connects the pump to the power source through a small hole in the abdomen. information.Allmedicalcodingmustbe biventricular pacemaker and implantable supportedwithdocumentation. cardioverter defibrillator which shocks the heart’s Implantable VADs are mainly used a person is rhythm back to normal. waiting for a heart transplant or as a long-term solution if they are not a transplant candidate. PRO_19316E Internal Approved 09052018 ©WellCare 2018 NA8PROBRO19316E_0000 Cardiac Arrhythmias is similar to . Additional treatments s/p pacemaker: (I47–I49) However, the heartbeats in atrial flutter are Patients who have a rapid heart rate as part Tachycardia (I47) more organized and more rhythmic. of their SSS may need additional treatments An arrhythmia is an abnormal heart rhythm. Treatment options may include but not after pacemaker placement to control fast A heart rate of more than 100 beats per Arrhythmias occur when the electrical limited to: rhythms. Treatments can include: minute in adults is called tachycardia. impulses that coordinate your heartbeats • Medications (beta blockers, calcium � • Medications There are 3 types of tachycardias: don’t work properly, causing your heart to channel blockers) � • Radiofrequency beat too fast, too slow or irregularly. • Atrial or Supraventricular Tachycardi • Pulmonary vein isolation ablation • AV node ablation (SVT) (i47.1) Causes: • AV node ablation with pacemaker • Sinus Tachycardia (R00.0) Coding tips: Many things can cause an arrhythmia, • Ventricular Tachycardia (I47.2) including Codes include: • SSS controlled by pacemaker - For • Scarring of heart tissue from a prior � • I48.0 Paroxysmal atrial fibrillation patients with SSS that is controlled by Causes: their pacemaker, coding guidelines advise heart attack � • I48.1 Persistent atrial fibrillation Many things can cause an arrhythmia, “no code assignment is required” for the including: • Changes to the heart’s structure, such as • I48.2 Chronic atrial fibrillation SSS. Instead, a code may be assigned for from cardiomyopathy • People who drink large amounts of • I48.3 Typical atrial flutter pacemaker presence, or for attention to • CAD, HTN, Diabetes, hyper- or the pacemaker (Z45.010, Z45.018). coffee or caffeinated substances • I48.4 Atypical atrial flutter hypothyroidism � • SSS s/p pacemaker, additional treatment • People of drink alcohol heavily • I48.91 Unspecified atrial fibrillation • Smoking required – SSS may be coded when • People of smoke heavily • I48.92 Unspecified atrial flutter additional treatment is required to Treatments may include: control the condition after placement Symptoms may include: I49.5 Sick sinus syndrome (SSS) of a pacemaker. This may occur when: • Antiarrhythmics • Fainting Also known as ‘Sinoatrial node dysfunction’ or − to control periods of fast • Beta blockers (reduce heart’s workload ‘Tachycardia-Bradycardia syndrome,’ sick sinus heart rate are combined with • Rapid heartbeat and decrease heart rate) syndrome is the name given to a group of pacemaker, which guards against • Lightheadedness or dizziness arrhythmias in which the sinus node, which is • Calcium channel blockers (reduce � periods of slow heart rate. • Angina heart rate) � responsible for setting the pace of the heart, − Pacemaker requires repair � doesn’t send impulses properly. The heart rate • Shortness of breath • or replacement. � may be too slow as a result, or it may speed • Pacemaker up and slow down intermittently. Documentation tips Treatment: • When documenting cardiac arrhythmias, Most people don’t need medical therapy. I48.- Atrial fibrillation and flutter Treatment with artificial pacemaker: include the following: Treatment is considered if episodes are Atrial fibrillation is a rapid, irregular heart rate Most people with sick sinus syndrome prolonged or occur often. Physicians might ✓ Location – atrial, ventricular, caused by chaotic electrical impulses in the eventually need a permanent artificial recommend: supraventricular, etc. atria. These cause rapid, uncoordinated, weak pacemaker to monitor and regulate the ✓ Rhythm name – flutter, fibrillation, etc. • Cutting down on caffeine and/or � contractions of the atria and blood is not heart’s rhythm and send electrical signals alcohol intake � moved from the atria into the to stimulate the heart when it’s beating ✓ Acuity – paroxysmal, chronic, etc. • Quit tobacco use ventricles effectively. too slowly. ✓ Cause – hyperkalemia, HTN, etc.