ICD-10 Coding for Syncope(R55, I95.1)
Complete ICD-10-CM coding and documentation guide for Syncope. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to 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 syncope occurs without a specific identifiable cause. |
|
| I95.1 | Orthostatic hypotension | Use when syncope is directly linked 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 syncope
Essential facts and insights about Syncope
Primary ICD-10-CM Codes for syncope
Decision Criteria
clinical Criteria
- No identifiable cause after thorough evaluation.
Clinical Validation Requirements
- Negative ECG
- Normal echocardiogram
- Tilt table test results
Code-Specific Risks
- Incorrectly using R55 when a specific cause is identified.
Coding Notes
- Ensure no specific cause is documented before using R55.
I95.1 - Orthostatic hypotension
Use when syncope is directly linked to orthostatic hypotension.
Excludes
- Syncope due to other causes
Clinical Validation Requirements
- Orthostatic BP measurements showing significant drop
Coding Notes
Document orthostatic BP readings clearly.
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 to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code R55.
Impact
Clinical: Misdiagnosis risk., Regulatory: Non-compliance with documentation standards., Financial: Potential claim denials.
Mitigation Strategy
Use structured documentation templates, Ensure thorough clinical evaluation
Impact
Reimbursement: Incorrect coding may lead to denied claims., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate health records.
Mitigation Strategy
Use the code for the specific cause, such as I95.1 for orthostatic hypotension.
Impact
Using R55 when a more specific diagnosis is available.
Mitigation Strategy
Review clinical documentation thoroughly 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 Syncope, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Syncope
Use these documentation templates to ensure complete and accurate documentation for Syncope. These templates include all required elements for proper coding and billing.
Syncope Evaluation
Specialty: CardiologyRequired Elements
- Onset and duration of syncope
- Precipitating factors
- Associated symptoms
- Recovery time
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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