Understanding Heart Block: Find information on first-degree, second-degree (Mobitz I Wenckebach, Mobitz II), and third-degree (complete) heart block. This resource covers diagnosis, ECG interpretation, treatment options, ICD-10 codes (I44.0, I44.1, I44.2), clinical documentation requirements, and healthcare provider resources for effective heart block management. Learn about atrioventricular (AV) node dysfunction, bundle branch block, symptoms, and bradycardia related to heart block.
Also known as
Atrioventricular and left bundle-branch block
Disruptions in the heart's electrical conduction system.
Other specified conduction disorders
Includes less common heart block variations not specified elsewhere.
Other conduction disorders
Covers unspecified or combined conduction disturbances in the heart.
Follow this step-by-step guide to choose the correct ICD-10 code.
Atrioventricular block present?
No
Do not code heart block. Look for other diagnoses.
Yes
Third-degree (complete) AV block?
When to use each related code
| Description |
|---|
| Heart Block |
| Atrioventricular Block |
| Bundle Branch Block |
Coding heart block without specifying the degree (first, second, third) leads to inaccurate DRG assignment and lost revenue.
Lack of clear documentation of the heart block type and associated symptoms hinders accurate coding and CDI queries.
Coexisting atrial fibrillation with heart block may be overlooked, impacting risk adjustment and quality reporting.
Q: What are the key electrocardiographic (ECG) findings that differentiate first-degree, second-degree (Mobitz I and II), and third-degree atrioventricular (AV) block?
A: Accurate ECG interpretation is crucial for differentiating AV block types. First-degree AV block presents with a prolonged PR interval (> 200 ms) without dropped beats. Second-degree Mobitz I (Wenckebach) shows progressively lengthening PR intervals culminating in a dropped QRS complex, with the RR interval shortening before the dropped beat. Mobitz II demonstrates consistent PR intervals with intermittently dropped QRS complexes without progressive PR lengthening. Third-degree (complete) AV block exhibits complete dissociation of P waves and QRS complexes; atrial and ventricular rates are independent. Explore how advanced ECG analysis techniques can help identify subtle conduction abnormalities and improve diagnostic accuracy. Consider implementing standardized ECG interpretation protocols in your practice to ensure consistent and reliable diagnosis of AV blocks.
Q: How do I manage a hemodynamically unstable patient presenting with a new onset complete heart block in the emergency department?
A: Managing a hemodynamically unstable patient with new-onset complete heart block requires prompt intervention. Immediate treatment focuses on stabilizing the patient with atropine while preparing for temporary transvenous or transcutaneous pacing. If atropine is ineffective or the patient remains unstable, initiate temporary pacing promptly. Once stable, further investigations should be conducted to determine the underlying etiology, such as myocardial infarction, drug toxicity, or infiltrative disease. Learn more about the advanced cardiac life support (ACLS) guidelines for managing bradycardia and heart block. Explore how implementing a rapid response protocol for unstable bradyarrhythmias can improve patient outcomes in the emergency department.
Patient presents with symptoms suggestive of heart block. Presenting complaints may include dizziness, syncope, lightheadedness, fatigue, shortness of breath, bradycardia, or palpitations. Electrocardiogram (ECG, EKG) findings confirm the diagnosis of heart block, demonstrating atrioventricular (AV) conduction delay or block. The specific type of heart block (first-degree heart block, second-degree heart block Mobitz type I Wenckebach, second-degree heart block Mobitz type II, or third-degree heart block complete heart block) is documented based on ECG interpretation including PR interval prolongation, dropped QRS complexes, and AV dissociation. The patient's heart rate and rhythm are noted. Assessment includes evaluation for underlying causes such as myocardial infarction, ischemia, cardiomyopathy, medication effects (e.g., beta-blockers, calcium channel blockers), or electrolyte imbalances. Differential diagnoses considered include sinus bradycardia, sick sinus syndrome, and other conduction system disorders. Treatment plan is based on the type and severity of heart block and the patient's hemodynamic stability. Options may include observation, medication adjustment, temporary pacing, or permanent pacemaker implantation. Patient education regarding symptoms, monitoring, and follow-up care is provided. ICD-10 code assigned (e.g., I44.0 - I44.3, I45.5, I45.8 depending on the specific type). CPT codes for procedures performed, such as ECG interpretation (93010) or pacemaker implantation (33206-33208, 33212-33213), are documented appropriately for medical billing and coding purposes. The patient's response to treatment and prognosis are discussed.