ICD-10 Coding for Presyncope(R55, I95.1, G90.01)
Complete ICD-10-CM coding and documentation guide for Presyncope. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Presyncope
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 presyncope occurs without a known underlying cause. |
|
| I95.1 | Orthostatic hypotension | Use when presyncope is due to orthostatic hypotension. |
|
| G90.01 | Carotid sinus syncope | Use when presyncope is due to carotid sinus hypersensitivity. |
|
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 presyncope
Essential facts and insights about Presyncope
Primary ICD-10-CM Codes for presyncope
Decision Criteria
clinical Criteria
- No identifiable underlying cause for presyncope.
coding Criteria
- No Excludes1 conditions present.
Clinical Validation Requirements
- Normal cardiac workup (ECG, echo)
- Negative orthostatic vitals
Code-Specific Risks
- Incorrect use when an Excludes1 condition is present.
Coding Notes
- Ensure no Excludes1 conditions are present when using R55.
I95.1 - Orthostatic hypotension
Use when presyncope is due to orthostatic hypotension.
Clinical Validation Requirements
- ≥20 mmHg SBP drop within 3 mins standing
- Documented dehydration/medication list
Coding Notes
Ensure orthostatic hypotension is documented with specific BP changes.
G90.01 - Carotid sinus syncope
Use when presyncope is due to carotid sinus hypersensitivity.
Clinical Validation Requirements
- Positive carotid sinus massage test
- Exclusion of cardiac arrhythmia
Coding Notes
Document the mechanism of carotid sinus sensitivity.
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 Presyncope 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 coding standards., Financial: Potential for denied claims.
Mitigation Strategy
Use detailed templates for documentation., Train staff on specific documentation requirements.
Impact
Reimbursement: May lead to incorrect DRG assignment., Compliance: Violates coding guidelines., Data Quality: Leads to inaccurate clinical data.
Mitigation Strategy
Verify if conditions like orthostatic hypotension are documented and use the appropriate code.
Impact
Using R55 with conditions like orthostatic hypotension.
Mitigation Strategy
Implement checks for Excludes1 conditions before 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 Presyncope, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Presyncope
Use these documentation templates to ensure complete and accurate documentation for Presyncope. These templates include all required elements for proper coding and billing.
Presyncope during standing
Specialty: Internal MedicineRequired Elements
- Trigger event
- Duration of symptoms
- Associated symptoms
- Blood pressure response
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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