ICD-10 Coding for Fainting(R55, I95.1)
Complete ICD-10-CM coding and documentation guide for Fainting. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Fainting
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| R55 | Syncope and collapse | Use when the patient experiences fainting without a specified underlying cause. |
|
| I95.1 | Orthostatic hypotension | Use when syncope is due to orthostatic hypotension. |
|
Clinical Decision Support
Always review the patient's clinical documentation thoroughly. When in doubt, choose the more specific code and ensure documentation supports it.
Key Information: ICD-10 code for fainting
Essential facts and insights about Fainting
Primary ICD-10-CM Codes for fainting
Decision Criteria
clinical Criteria
- Patient experienced sudden loss of consciousness with spontaneous recovery.
coding Criteria
- No Excludes1 conditions present.
Applicable To
- Vasovagal syncope
- Situational syncope
Clinical Validation Requirements
- Sudden, temporary loss of consciousness
- Spontaneous recovery
Code-Specific Risks
- Ensure no Excludes1 conditions are present.
Coding Notes
- Ensure documentation supports the absence of Excludes1 conditions.
I95.1 - Orthostatic hypotension
Use when syncope is due to orthostatic hypotension.
Excludes
- Neurogenic orthostatic hypotension (G90.3)
Clinical Validation Requirements
- Blood pressure drop ≥20mmHg systolic or ≥10mmHg diastolic upon standing
Coding Notes
Document orthostatic vital signs clearly.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Orthostatic hypotension
I95.1Transient cerebral ischemia
G45.9Syncope and collapse
R55Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Fainting to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code R55.
Impact
Clinical: May lead to misdiagnosis., Regulatory: Non-compliance with documentation standards., Financial: Potential for denied claims.
Mitigation Strategy
Ensure complete documentation of the syncope event.
Impact
Reimbursement: Incorrect sequencing can lead to improper DRG assignment., Compliance: Non-compliance with coding guidelines., Data Quality: Affects the accuracy of clinical data.
Mitigation Strategy
Sequence the underlying cause first, followed by R55.
Impact
Incorrect sequencing of syncope and underlying conditions.
Mitigation Strategy
Regular training on ICD-10 coding guidelines.
Documentation errors, coding pitfalls, and audit risks are interconnected aspects of medical coding and billing. Addressing all three areas helps ensure accurate coding, optimal reimbursement, and regulatory compliance.
Frequently Asked Questions
Common questions about ICD-10 coding for Fainting, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Fainting
Use these documentation templates to ensure complete and accurate documentation for Fainting. These templates include all required elements for proper coding and billing.
Emergency Department visit for syncope
Specialty: Emergency MedicineRequired Elements
- History of present illness
- Review of systems
- Physical examination
- Diagnostic studies
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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