Among the top 25 diagnosis codes worked up in the emergency department and coded by McKesson is Syncope (ICD-9 – 780.2). Syncope is commonly known as “fainting or passing out and is defined as a short loss of consciousness and muscle strength”1.
Syncope is characterized through cardiovascular disease, exertional, heat-related, from hyperventilation and by hysterical types. Syncope is often the result of an underlying condition that could be related to the heart, nervous system or blood flow to the brain. In about one-third of cases, the cause of syncope is unknown. In the elderly, it is not uncommon for syncope to occur as the result of more than one cause.
When syncope symptoms are associated with palpations (feelings of having rapid, fluttering or pounding heart), any of these symptoms indicates an abrupt drop in cardiac output and denotes a serious arrhythmia or underlying organic heart disease. Exertional syncope occurs in aortic stenosis (narrowing of the heart’s aortic valve) or hypertrophic cardiomyopathy (a thickening of the heart muscle), both of which limit increased cardiac output on exertion. Mild heat exhaustion, precipitated by prolonged standing in a hot environment is manifested by a subnormal body temperature and simple syncope. Vasovagal syncope, which is typically precipitated by unpleasant stimuli (i.e. pain, fright, sight of blood), usually occurs in the upright posture and is often preceded by warning symptoms like nausea, weakness, yawning, apprehension, visual blurring and sweating.
In young people without cardiovascular disease, syncope of unknown cause has a favorable prognosis and comprehensive evaluation is rarely required. In contrast, in the elderly, syncope may be the interaction of co-existing problems that may impair cardiovascular compensatory mechanisms.
Typically, assuming the horizontal posture ends the syncopal episode, no further treatment is necessary unless required by an underlying cause. Bradyarrhythmias (slow heartbeat), may require pace-maker implantation and tachyarrhythmias (fast heartbeat) require specific drug therapy.
There is a one-to-one crosswalk (ICD-9 to ICD-10) for Syncope – see table below.
As mentioned above, treatment for syncope depends on the patient’s presentation, age, and any underlying conditions that may be present or the patient has had historically.
It is imperative that the provider document exactly what the examination and the diagnostic studies’ findings are, if any, to determine the exact course of action for the condition presented or defined after study.