I47.2
I47 — Paroxysmal tachycardia
Chapter 9: Diseases of the Circulatory System (I00-I99)
I44-I49: Other cardiac arrhythmias
Clinical Definition
Ventricular tachycardia (VT) is a potentially life-threatening cardiac arrhythmia originating from the ventricles, characterized by three or more consecutive ventricular complexes at a rate exceeding 100 beats per minute. The rhythm arises from abnormal automaticity, triggered activity, or re-entrant circuits within the ventricular myocardium. VT can present as either sustained (lasting 30 seconds or longer, or requiring intervention due to hemodynamic compromise) or non-sustained (NSVT), which self-terminates within 30 seconds. On ECG, VT typically presents with wide QRS complexes (>120 ms), AV dissociation, and a regular or slightly irregular ventricular rate, usually between 140 and 250 bpm.
Non-sustained ventricular tachycardia (NSVT) is defined as three or more consecutive premature ventricular complexes at a rate of more than 100 bpm, lasting less than 30 seconds, and terminating spontaneously without hemodynamic compromise. NSVT is commonly detected on ambulatory monitoring (Holter) or telemetry and can occur in structurally normal hearts as well as in the setting of structural heart disease, electrolyte abnormalities, ischemia, or cardiomyopathy. While often asymptomatic, NSVT in certain clinical contexts (e.g., post-myocardial infarction, hypertrophic cardiomyopathy, reduced ejection fraction) carries prognostic significance and may warrant further evaluation or treatment.
ICD-10-CM does not distinguish between sustained and non-sustained ventricular tachycardia. Both are classified under I47.2. Clinical documentation should clearly specify whether the VT episode was sustained or non-sustained, the duration, the ventricular rate, hemodynamic stability, the clinical context in which it occurred, and any treatment administered. This documentation supports medical necessity, accurate risk stratification, and appropriate reimbursement even though the ICD-10-CM code is the same.
When to Use I47.2
- ✓Patient presents with documented ventricular tachycardia (sustained or non-sustained) on ECG, telemetry, Holter monitor, or cardiac event monitor
- ✓Coding episodes of NSVT detected during inpatient telemetry monitoring or ambulatory rhythm monitoring
- ✓Patient with known structural heart disease (e.g., ischemic cardiomyopathy, HCM, ARVC) found to have ventricular tachycardia during evaluation
- ✓Documentation of VT as the underlying arrhythmia prompting ICD (implantable cardioverter-defibrillator) implantation or antiarrhythmic therapy
- ✓VT storm or recurrent episodes of ventricular tachycardia requiring emergency department evaluation or hospital admission
- ✓Coding monomorphic or polymorphic ventricular tachycardia when the documentation does not specify torsades de pointes (which has its own code consideration under I47.2 as well)
Common Coding Mistakes
- ⚠Confusing I47.2 (ventricular tachycardia) with I49.01 (ventricular fibrillation) — VT is an organized rapid ventricular rhythm with identifiable QRS complexes, while VFib is a disorganized, chaotic rhythm without identifiable QRS complexes and is immediately life-threatening
- ⚠Using I49.3 (ventricular premature depolarization) when the documentation describes three or more consecutive PVCs at >100 bpm — this meets the definition of NSVT and should be coded as I47.2, not I49.3
- ⚠Assuming a separate ICD-10 code exists for non-sustained ventricular tachycardia — ICD-10-CM uses I47.2 for both sustained and non-sustained VT; there is no distinct code for NSVT
- ⚠Coding I47.1 (supraventricular tachycardia) when the arrhythmia originates from the ventricles — SVT (I47.1) originates above the ventricles, while VT (I47.2) originates from the ventricles; ECG morphology and clinical documentation must guide code selection
- ⚠Failing to assign I47.2 as a secondary diagnosis when VT or NSVT is incidentally found during an admission for another primary condition — this can affect severity of illness scoring, risk adjustment, and reimbursement
Related & Differential Codes
| Code | Description | Relationship |
|---|---|---|
| I47.0 | Re-entrant ventricular arrhythmia | Sibling |
| I47.1 | Supraventricular tachycardia (SVT) | Sibling |
| I49.01 | Ventricular fibrillation | Related |
| I49.02 | Ventricular flutter | Related |
| I49.3 | Ventricular premature depolarization (PVCs) | Related |
| I47 | Paroxysmal tachycardia | Parent |
Documentation Requirements
- 1Specify whether the ventricular tachycardia is sustained (>=30 seconds or requiring intervention) or non-sustained (<30 seconds, self-terminating)
- 2Document the method of detection: 12-lead ECG, continuous telemetry, Holter monitor, event recorder, or ICD interrogation
- 3Record the ventricular rate, QRS morphology (monomorphic vs. polymorphic), and episode duration when available
- 4Note hemodynamic status during the episode: stable (asymptomatic or mild symptoms) vs. unstable (hypotension, syncope, altered consciousness, chest pain)
- 5Document the clinical context and any underlying conditions: ischemic heart disease, cardiomyopathy, electrolyte abnormalities, QT prolongation, or drug-related causes
- 6Record treatment administered: observation only, antiarrhythmic medications (e.g., amiodarone, lidocaine), electrical cardioversion, or ICD therapy (shock or antitachycardia pacing)
- 7Include any relevant prior history: previous VT episodes, prior cardiac arrest, existing ICD, or prior ablation procedures
Reimbursement & Billing Notes
I47.2 is recognized as a clinically significant diagnosis that supports medical necessity for cardiac monitoring, electrophysiology consultations, antiarrhythmic drug therapy, and device-based interventions including ICD implantation. When documented as a secondary diagnosis during inpatient stays, ventricular tachycardia can impact DRG assignment, increase case weight, and affect severity of illness and risk of mortality scoring through CMS-HCC risk adjustment models. Accurate documentation of sustained versus non-sustained VT, hemodynamic stability, and treatment rendered is critical for supporting the level of care billed.
For outpatient encounters, I47.2 supports reimbursement for extended cardiac monitoring (e.g., CPT 93224-93272 for Holter and event monitors), electrophysiology studies (CPT 93600-93662), and catheter ablation procedures (CPT 93654 for VT ablation). Payers may require documentation of the arrhythmia burden, symptom correlation, and failure of conservative management to authorize advanced interventions. When coding NSVT specifically, ensure documentation explicitly states the arrhythmia type to avoid claim denials or downcoding, as some payers may question the medical necessity of aggressive workup for asymptomatic, non-sustained episodes without supporting clinical context.
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Try Free — No Credit Card RequiredFrequently Asked Questions
What is the ICD-10 code for NSVT (non-sustained ventricular tachycardia)?
The ICD-10-CM code for NSVT is I47.2 — Ventricular tachycardia. ICD-10-CM does not provide separate codes for sustained versus non-sustained ventricular tachycardia. Both sustained VT and NSVT are classified under I47.2. Clinical documentation should clearly specify that the episode was non-sustained (lasting less than 30 seconds and self-terminating) to support accurate clinical communication and medical decision-making, even though the code assignment is the same.
Is there a separate ICD-10 code for non-sustained versus sustained ventricular tachycardia?
No. ICD-10-CM uses a single code, I47.2, for all forms of ventricular tachycardia regardless of duration or sustained status. There is no separate code to distinguish non-sustained VT (NSVT) from sustained VT. However, thorough clinical documentation specifying the type (sustained vs. non-sustained), duration, rate, and hemodynamic impact is essential for appropriate clinical care, risk stratification, and supporting medical necessity for any workup or treatment billed.
What is the difference between ICD-10 codes I47.2 and I49.01?
I47.2 represents ventricular tachycardia, an organized rapid rhythm originating from the ventricles with identifiable (though wide) QRS complexes and a rate typically between 140 and 250 bpm. I49.01 represents ventricular fibrillation, a disorganized, chaotic electrical activity in the ventricles with no identifiable QRS complexes, which results in no effective cardiac output and is immediately life-threatening, requiring emergent defibrillation. While VT can degenerate into VFib, they are distinct arrhythmias with different ECG characteristics, clinical presentations, and treatment protocols.
How do I code NSVT found on telemetry or Holter monitoring?
NSVT detected on telemetry or Holter monitoring is coded as I47.2 (Ventricular tachycardia). Document the method of detection (telemetry, Holter, event monitor), the number of episodes, the longest run duration, the maximum ventricular rate, and whether the patient was symptomatic. If the monitoring was the primary reason for the encounter, the appropriate Z-code or symptom code (e.g., R00.0 for tachycardia or R00.2 for palpitations) may be listed as the primary diagnosis, with I47.2 as a secondary finding. If NSVT is the established diagnosis driving the encounter, I47.2 should be the primary diagnosis.
When should I use I49.3 (PVCs) versus I47.2 (ventricular tachycardia)?
Use I49.3 for isolated premature ventricular complexes (PVCs), couplets (two consecutive PVCs), or ventricular bigeminy/trigeminy patterns that do not meet the definition of ventricular tachycardia. Use I47.2 when there are three or more consecutive ventricular complexes at a rate exceeding 100 beats per minute, which defines ventricular tachycardia (either sustained or non-sustained). The distinction is critical: frequent PVCs and short runs of NSVT may coexist, and both codes may be reported when documentation supports both diagnoses.
Does I47.2 cover torsades de pointes?
Torsades de pointes (TdP) is a specific form of polymorphic ventricular tachycardia occurring in the setting of QT prolongation. In ICD-10-CM, torsades de pointes does not have a unique code and is classified under I47.2 (Ventricular tachycardia). Documentation should clearly describe the rhythm as torsades de pointes, note the underlying QT prolongation (which may be separately coded), and identify any precipitating factors such as medications, electrolyte imbalances, or congenital long QT syndrome to support the full clinical picture.