Conventional Arrhythmia Patients
Patients receiving an ICD conventionally have documented arrhythmias, non-sustained ventricular tachycardia plus inducible sustained ventricular tachycardia in the EP lab or familial or inherited conditions with high risk of life-threatening arrhythmia that are coded as the indication for receiving the device.  The following diagnosis codes indicate arrhythmia, or familial or inherited conditions.

425.1    Hypertrophic obstructive cardiomyopathy
427.1    Paroxysmal ventricular tachycardia
427.41  Ventricular fibrillation
427.42  Ventricular flutter
427.5    Cardiac arrest

Some local carriers may require a secondary diagnosis.

ICD-9-CM does not have a specific code for the inherited condition Long QT Syndrome.  This can only be shown with a general code:

794.31  Abnormal electrocardiogram

MADIT II or SCD-HeFT Patients
MADIT II patients represent a patient population who have a survived a previous myocardial infarction and have impairment of the left ventricle but no prior history of arrhythmia.  To properly communicate the indication for these patients, it is important to reflect heart failure or prior MI as the principal diagnosis rather than an arrhythmia.

SCD-HeFT patients represent a patient population with either ischemic or non-ischemic cardiomyopathy with NYHA Class II and III CHF and EF of less than or equal to 35%.  To fully communicate the indication it is important to reflect a principal diagnosis that is not related to an arrhythmia, but rather heart failure or cardiomyopathy.

The SCD-HeFT population includes but is broader than the MADIT II population which is the reason for the overlap.  For example, a prior MI is a MADIT II indication but may or may not be present in a SCD-HeFT patient.  Also, both MADIT II and SCD-HeFT criteria may include abnormalities in QRS duration.

Heart failure

402.01   Hypertensive heart disease, malignant, with heart failure
402.11   Hypertensive heart disease, benign, with heart failure
402.91   Hypertensive heart disease, unspecified, with heart failure
404.01   Hypertensive heart and renal disease, malignant, with heart failure
404.03   Hypertensive heart and renal disease, malignant, with heart failure and
              renal failure
404.11   Hypertensive heart and renal disease, benign, with heart failure
404.13   Hypertensive heart and renal disease, benign, with heart failure and
              renal failure
404.91   Hypertensive heart and renal disease, unspecified, with heart failure
404.93   Hypertensive heart and renal disease, unspecified, with heart failure
               and renal failure
428.0      Congestive heart failure, unspecified
428.1      Left heart failure
428.20    Systolic heart failure, unspecified
428.21    Systolic heart failure, acute
428.22    Systolic heart failure, chronic
428.23    Systolic heart failure, acute on chronic
428.30    Diastolic heart failure, unspecified
428.31    Diastolic heart failure, acute
428.32    Diastolic heart failure, chronic
428.33    Diastolic heart failure, acute on chronic
428.40    Combined systolic and diastolic heart failure, unspecified
428.41    Combined systolic and diastolic heart failure, acute
428.42    Combined systolic and diastolic heart failure,  chronic
428.43    Combined systolic and diastolic heart failure, acute on chronic
428.9      Heart failure, unspecified

Prior Myocardial Infarction

410.00-410.92  Acute myocardial infarction
412      Old myocardial infarction
414.8     Other specified forms of chronic ischemic heart disease

The MI codes vary depending on when the MI occurred and whether it still presents symptoms.   In 410 series, the fifth digit shows the episode of care: unspecified, initial or subsequent.  Although the MI must be prior, the code may reflect an initial episode of care for patients with lengthy stays or transfers of care.

QRS Duration, Wide and Narrow

ICD-9-CM does not have specific codes for variations or abnormalities in QRS duration.  This can only be shown with a general code:

794.31 Abnormal electrocardiogram

Cardiomyopathy, Ischemic and Non-Ischemic

ICD-9-CM has one diagnosis code for ischemic cardiomyopathy:

414.8  Other specified forms of chronic ischemic heart disease

Note that this code is also used when the diagnosis is ischemic congestive cardiomyopathy.

Non-ischemic cardiomyopathy is generally assigned to just one code:

425.4  Other primary cardiomyopathies.

This code includes almost all other forms of primary cardiomyopathy such as idiopathic, hypertrophic, dilated, congestive (non-ischemic), obstructive, constrictive, and restrictive forms of cardiomyopathy.  One exception is hypertrophic obstructive cardiomyopathy which is coded 425.1.

If you have any questions, please contact Allison Waxler at awaxler@hrsonline.org or 202-464-3433.