ICD-10 Coding for Near Syncope(R55, I95.1)
Complete ICD-10-CM coding and documentation guide for Near Syncope. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Near Syncope
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 near syncope occurs without a specific identifiable cause. |
|
| I95.1 | Orthostatic hypotension | Use when near 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 near syncope
Essential facts and insights about Near Syncope
Primary ICD-10-CM Codes for near syncope
Decision Criteria
clinical Criteria
- Near syncope with no identifiable cause
coding Criteria
- Absence of orthostatic hypotension
Applicable To
- Near syncope
- Vasovagal attack
Excludes
- Orthostatic hypotension (I95.1)
Clinical Validation Requirements
- Documented episode of near syncope
- No loss of consciousness
- Absence of identifiable cause
Code-Specific Risks
- Incorrect use when orthostatic hypotension is present
Coding Notes
- Ensure no underlying cause is documented before using R55 as primary.
I95.1 - Orthostatic hypotension
Use when near syncope is due to orthostatic hypotension.
Clinical Validation Requirements
- Drop in systolic blood pressure ≥20 mmHg upon standing
- Symptoms of dizziness or lightheadedness
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.
Nausea
R11.0Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Near Syncope to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code R55.
Impact
Clinical: Misdiagnosis of syncope type., Regulatory: Non-compliance with coding standards., Financial: Potential for incorrect billing and reimbursement.
Mitigation Strategy
Ensure orthostatic vitals are part of the standard workup for syncope.
Impact
Reimbursement: Incorrect DRG assignment may lead to reimbursement issues., Compliance: Non-compliance with ICD-10 coding guidelines., Data Quality: Inaccurate clinical data representation.
Mitigation Strategy
Use I95.1 if orthostatic hypotension is confirmed.
Impact
Using R55 instead of I95.1 when orthostatic hypotension is present.
Mitigation Strategy
Educate providers on proper documentation and coding.
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 Near Syncope, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Near Syncope
Use these documentation templates to ensure complete and accurate documentation for Near Syncope. These templates include all required elements for proper coding and billing.
Emergency Department Visit for Near Syncope
Specialty: Emergency MedicineRequired Elements
- Timeframe of episode
- Triggers and associated symptoms
- Orthostatic vital signs
- Absence of loss of consciousness
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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