ICD-10 Coding for Faintness(R55, I95.1)
Complete ICD-10-CM coding and documentation guide for Faintness. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Faintness
R42-R55Primary Range
Symptoms and signs involving cognition, perception, emotional state and behavior
This range includes codes for dizziness, giddiness, and syncope, which are relevant to faintness.
Hypotension
Includes orthostatic hypotension, which can cause faintness and should be coded if identified as the cause.
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 faintness results in a transient loss of consciousness without a known cause. |
|
| I95.1 | Orthostatic hypotension | Use when faintness is due to orthostatic hypotension confirmed by blood pressure measurements. |
|
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 faintness
Essential facts and insights about Faintness
Primary ICD-10-CM Codes for faintness
Decision Criteria
clinical Criteria
- Patient experiences transient loss of consciousness with spontaneous recovery.
coding Criteria
- No underlying cause identified or documented.
Applicable To
- Fainting
- Vasovagal syncope
Excludes
- Psychogenic syncope (F41.8)
Clinical Validation Requirements
- Transient loss of consciousness
- Spontaneous recovery
Code-Specific Risks
- Misclassification if underlying cause is identified but not coded
Coding Notes
- Ensure documentation supports the transient nature of syncope.
I95.1 - Orthostatic hypotension
Use when faintness is due to orthostatic hypotension confirmed by blood pressure measurements.
Applicable To
- Postural hypotension
Excludes
- Hypotension NOS (I95.9)
Clinical Validation Requirements
- Blood pressure drop ≥20 mmHg systolic or ≥10 mmHg diastolic upon standing
Coding Notes
Document orthostatic vitals to support coding.
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.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Faintness to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code R55.
Impact
Clinical: Inaccurate diagnosis of syncope etiology., Regulatory: Non-compliance with coding guidelines., Financial: Potential for denied claims or incorrect reimbursement.
Mitigation Strategy
Use templates to ensure all necessary vitals are recorded., Educate staff on importance of orthostatic measurements.
Impact
Reimbursement: Incorrect sequencing can affect DRG assignment and reimbursement., Compliance: Non-compliance with ICD-10 sequencing rules., Data Quality: Misrepresentation of the patient's condition in medical records.
Mitigation Strategy
Code I95.1 as primary and R55 as secondary.
Impact
Coding R55 as primary when orthostatic hypotension is documented can lead to audit findings.
Mitigation Strategy
Educate coders on proper sequencing rules and ensure documentation supports coding decisions.
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 Faintness, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Faintness
Use these documentation templates to ensure complete and accurate documentation for Faintness. These templates include all required elements for proper coding and billing.
Patient presenting with faintness in a cardiology clinic
Specialty: CardiologyRequired Elements
- Orthostatic blood pressure measurements
- ECG findings
- Tilt table test results
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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