ICD-10 Coding for Syncope Episode(R55, I95.1)
Complete ICD-10-CM coding and documentation guide for Syncope Episode. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Syncope Episode
R55Primary Range
Syncope and collapse
This code is used when syncope occurs without a confirmed underlying cause.
Orthostatic hypotension
Used when syncope is due to orthostatic hypotension, not to be used with R55 unless unrelated.
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 no underlying cause is identified after evaluation. |
|
| 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: When can R55 be used as a principal diagnosis?
Essential facts and insights about Syncope Episode
Primary ICD-10-CM Codes for syncope episode
Decision Criteria
clinical Criteria
- No underlying cause found after comprehensive evaluation.
coding Criteria
- Do not use with Excludes1 conditions unless unrelated.
Applicable To
- Fainting
- Temporary loss of consciousness
Clinical Validation Requirements
- Transient loss of consciousness with spontaneous recovery
- No structural heart disease on echocardiogram
Code-Specific Risks
- Improper use with Excludes1 conditions
- Incorrect sequencing with underlying causes
Coding Notes
- Ensure no Excludes1 conditions are coded with R55.
I95.1 - Orthostatic hypotension
Use when syncope is due to orthostatic hypotension.
Applicable To
- Postural hypotension
Excludes
- Syncope (R55)
Clinical Validation Requirements
- BP drop 25/10 mmHg within 3 mins standing
- Dizziness upon standing
Coding Notes
Ensure orthostatic vitals are documented.
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 Syncope Episode to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code R55.
Impact
Clinical: Missed diagnosis of cardiac-related syncope., Regulatory: Non-compliance with clinical documentation standards., Financial: Potential claim denials due to insufficient documentation.
Mitigation Strategy
Ensure ECG is performed and results documented for all syncope admissions.
Impact
Reimbursement: Potential claim denial due to Excludes1 conflict., Compliance: Non-compliance with ICD-10 guidelines., Data Quality: Inaccurate clinical data representation.
Mitigation Strategy
Use I95.1 only if orthostatic hypotension is the confirmed cause.
Impact
Coding R55 with I95.1 when related.
Mitigation Strategy
Educate coders on Excludes1 notes and proper sequencing.
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 Syncope Episode, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Syncope Episode
Use these documentation templates to ensure complete and accurate documentation for Syncope Episode. These templates include all required elements for proper coding and billing.
Patient presents with syncope in the emergency department.
Specialty: Emergency MedicineRequired Elements
- Orthostatic vitals
- ECG results
- Troponin levels
- Disposition plan
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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