Is there a specified ICD-10 (International Classification of Diseases, 10th Revision) code for a patient with sinus tachycardia?

ICD-10 Coding for Sinus Tachycardia

Yes, there is a specific ICD-10 code for sinus tachycardia: R00.0 (Tachycardia, unspecified) is used for physiological sinus tachycardia, while I49.5 (Sick sinus syndrome) may apply in certain contexts, though the most appropriate code depends on whether the tachycardia is physiological, inappropriate, or secondary to another condition.

Primary Coding Options

For straightforward sinus tachycardia, use R00.0 1:

• This code captures tachycardia when the heart rate exceeds 100 bpm in sinus rhythm
• The P wave should be upright in leads I, II, and aVF and biphasic in lead V1 to confirm sinus origin 1
• This is the default code when sinus tachycardia is documented without further specification

Context-Specific Coding Considerations

Code the underlying cause first when sinus tachycardia is secondary 1:

• Physiological sinus tachycardia results from appropriate autonomic responses to infection with fever, dehydration, anemia, heart failure, hyperthyroidism, pain, anxiety, or exogenous substances including caffeine, beta-agonists, or illicit stimulants 1
• In these cases, code the primary condition (e.g., J18.9 for pneumonia, E05.90 for hyperthyroidism, D50.9 for anemia) and add R00.0 as a secondary diagnosis 1
• The tachycardia is expected to resolve with correction of the underlying cause 1

For inappropriate sinus tachycardia (IST), consider I49.8 (Other specified cardiac arrhythmias) 1:

• IST is defined as sinus tachycardia unexplained by physiological demands with resting heart rates >100 bpm and average rates >90 bpm over 24 hours 1
• This is a diagnosis of exclusion requiring elimination of all secondary causes including hyperthyroidism, anemia, dehydration, pain, exogenous substances, and anxiety 1
• Approximately 90% of IST patients are female with mean age of presentation 38 years 1

Important Coding Pitfalls to Avoid

Do not use codes for other supraventricular tachycardias 1:

• Sinus tachycardia must be distinguished from atrial tachycardia arising from the superior crista terminalis, sinus node reentrant tachycardia, and postural orthostatic tachycardia syndrome 1
• A 12-lead ECG is essential to confirm P-wave morphology consistent with sinus origin before coding 1

Avoid coding IST without proper diagnostic workup 1:

• IST requires documentation of persistent sinus tachycardia with excessive rate increase in response to activity, nocturnal normalization on 24-hour Holter recording, nonparoxysmal nature, P-wave morphology identical to sinus rhythm, and exclusion of secondary systemic causes 1
• The diagnosis should not be made in the acute setting without ruling out reversible causes 1

Documentation Requirements for Accurate Coding

Ensure clinical documentation specifies 1:

• Whether the tachycardia is physiological/appropriate versus inappropriate
• The presence or absence of underlying causes (infection, hypovolemia, anemia, thyroid disease, medications, substances)
• Heart rate values at rest and with activity
• Associated symptoms (palpitations, chest pain, dyspnea, dizziness, lightheadedness, presyncope) 1
• Results of diagnostic workup including ECG, Holter monitoring if performed, and laboratory evaluation 1