Find comprehensive information on Wolff-Parkinson-White syndrome diagnosis, including clinical documentation requirements, ICD-10 codes (I45.6), medical coding guidelines, and healthcare resources. Learn about WPW syndrome symptoms, ECG interpretation with delta waves, pre-excitation, atrioventricular reentrant tachycardia (AVRT), ablation procedures, and differential diagnosis. This resource supports accurate medical coding and clinical documentation for healthcare professionals.
Also known as
Wolff-Parkinson-White syndrome
Specific code for Wolff-Parkinson-White syndrome.
Pre-excitation syndrome
Includes other pre-excitation syndromes besides WPW.
Other specified cardiac arrhythmias
If WPW manifests with unusual arrhythmias, this may be used.
Paroxysmal tachycardia, unspecified
For cases where WPW presents as paroxysmal tachycardia without further specification.
Follow this step-by-step guide to choose the correct ICD-10 code.
Is WPW manifest (symptomatic)?
Yes
Atrial fibrillation present?
No
Code I47.20, Wolff-Parkinson-White syndrome, asymptomatic
When to use each related code
| Description |
|---|
| Shortened PR, delta wave, SVT |
| Rapid regular narrow QRS SVT |
| Rapid regular narrow QRS SVT |
Incorrectly coding other SVTs as WPW due to similar ECG findings, leading to inaccurate reporting and treatment.
Using only I47.0 (WPW) without specifying type (manifest/concealed) or complications, impacting risk adjustment.
Insufficient documentation of ECG findings, symptoms, and family history, hindering accurate coding and audit defense.
Q: How can I differentiate Wolff-Parkinson-White (WPW) syndrome from other supraventricular tachycardias (SVTs) during ECG interpretation in a symptomatic patient?
A: Differentiating WPW syndrome from other SVTs relies on identifying key ECG features during sinus rhythm and tachycardia. In sinus rhythm, look for a shortened PR interval (<120ms), a delta wave (slurred upstroke of the QRS complex), and QRS widening (>100ms). During tachycardia, WPW typically presents as orthodromic atrioventricular reentrant tachycardia (AVRT) with a narrow QRS complex tachycardia, or less commonly, as antidromic AVRT with a wide QRS complex tachycardia resembling ventricular tachycardia. Pre-excitation during sinus rhythm is the most specific finding for WPW. However, the delta wave can be intermittent or concealed, making diagnosis challenging. Consider comparing current and previous ECGs, if available, to identify subtle pre-excitation changes. Explore how advanced ECG analysis tools can aid in identifying concealed delta waves and differentiating WPW from other SVTs. If the diagnosis remains uncertain, electrophysiology consultation is recommended for definitive diagnosis and management.
Q: What are the best management strategies for acute episodes of symptomatic Wolff-Parkinson-White syndrome with atrioventricular reentrant tachycardia (AVRT) in hemodynamically stable patients?
A: For hemodynamically stable patients experiencing symptomatic AVRT in the setting of WPW, vagal maneuvers (e.g., Valsalva maneuver, carotid sinus massage) can be attempted initially. If vagal maneuvers are unsuccessful, intravenous adenosine is often the first-line pharmacological therapy. Other options include procainamide or ibutilide. Avoid AV nodal blocking agents like verapamil, diltiazem, and digoxin in patients with antidromic AVRT or pre-excited atrial fibrillation, as these can paradoxically increase the ventricular rate and precipitate ventricular fibrillation. Consider implementing a standardized protocol for managing acute WPW episodes in your clinical setting. Learn more about the risks and benefits of different pharmacological and non-pharmacological interventions for WPW.
Patient presents with complaints consistent with Wolff-Parkinson-White syndrome (WPW). Symptoms include palpitations, tachycardia, shortness of breath, dizziness, and presyncope. The patient reports episodic rapid heartbeat, sometimes associated with chest discomfort. Electrocardiogram (ECG, EKG) reveals a shortened PR interval, delta wave, and widened QRS complex, indicative of pre-excitation. Diagnostic criteria for Wolff-Parkinson-White are met based on ECG findings. Differential diagnosis includes other supraventricular tachycardias, such as atrioventricular nodal reentrant tachycardia (AVNRT) and atrioventricular reciprocating tachycardia (AVRT). Patient history is negative for structural heart disease. Current medications include none. Treatment plan includes discussion of catheter ablation for definitive management of the accessory pathway. Patient education provided regarding the risks and benefits of catheter ablation, as well as the potential for future arrhythmia recurrence. Pharmacological management options, including antiarrhythmic medications such as flecainide or propafenone, were also discussed as a bridge to ablation or for long-term management if ablation is not pursued. The patient will be referred to an electrophysiologist for further evaluation and consideration of ablation. Follow-up scheduled in two weeks to discuss treatment options and schedule any necessary procedures. ICD-10 code I45.6, Wolff-Parkinson-White syndrome, is documented.