Coding Tip: Atrial Fibrillation
Kim Carrier RHIT, CDIP, CCS, CCS-P
Director of Coding Quality Assurance
AHIMA Approved ICD-10-CM/PCS Trainer
Atrial Fibrillation – What is it and how do you code it?
With the implementation of ICD-10-CM came more codes for reporting many different conditions and diseases, and atrial fibrillation is one of those. For many years there was only one code available for reporting this condition, even when the physician further specified the type of atrial fibrillation that the patient had. In ICD-10-CM, there are four codes to report atrial fibrillation:
- I48.91 is used to report atrial fibrillation when no further specificity is available
- I48.2 is used to report atrial fibrillation when specified as chronic or permanent (Will be expanded 10/1/19)
- I48.0 is used to report atrial fibrillation when specified as paroxysmal
- I48.1 is used to report atrial fibrillation when specified as persistent (Will be expanded 10/1/19)
What is atrial fibrillation?
Atrial fibrillation is an irregular heartbeat or arrhythmia sometimes called a quivering heart. This arrhythmia can cause a patient to develop blood clots, have a stroke, heart failure or other conditions. The heart rate is most often rapid and causes poor blood flow. When a patient is in atrial fibrillation, the upper chambers of the heart (atria) are beating differently than the lower chambers (ventricles). When this occurs, the irregular rhythm/heartbeat, prohibits the atria from contracting/relaxing and causes ineffectual filling and emptying of the ventricles. This is referred to often as a chaotic dysrhythmia.
The causes of atrial fibrillation is oftentimes unknown, but can be the result of damage to the heart’s electrical system caused by conditions such as uncontrolled hypertension and coronary artery disease. Atrial fibrillation can develop in any person including children but the risk is higher in patients of advanced age, have hypertension, have underlying heart disease, binge drinking of alcoholic beverages, family history, sleep apnea sufferers, athletes, patients with thyroid disease, diabetes and asthma are some of the more common disease that put a patient at higher risk for developing atrial fibrillation.
Controlling the disease that causes the erratic heartbeat is a must, as well as treating the arrhythmia. Sometimes treating and controlling the underlying cause will make the atrial fibrillation go away. If this does not help the erratic rhythm, then the patient may require treatment with beta blockers and calcium channel blockers to help slow the heart rate. The rhythm should be restored to a normal rhythm to reduce the high heart rate. Patients are often placed on a blood thinner to help prevent blood clot and stroke in addition to the rate and rhythm controller medication. The rhythm should be restored to a normal rhythm to reduce the high heart rate. There are other treatments available such as electrical cardioversion, radiofrequency/catheter ablation, pacemakers and an open heart maze procedure for the atrial fibrillation that does not correct on its own or does not respond to the medications.
How to code multiple documented types of atrial fibrillation?
The most recent coding advice has addressed how to report the appropriate code for the atrial fibrillation when more than one type is documented. Per this advice, if the physician diagnoses the patient with chronic persistent atrial fibrillation only the code I48.1 (persistent atrial fibrillation) is reported. The term chronic is a nonspecific term that could also be used to describe the other types of specified atrial fibrillation. Since I48.1 is a more specific code this is the one that should be reported. Even though the Alphabetic Index within ICD-10-CM has listed the different types of atrial fibrillation at the same indention level, only one code is reported. The most specific term should be reported.
Atrial Fibrillation Coding Tips:
- Atrial fibrillation is still reported in patients that are not currently experiencing the erratic rhythm as long as the patient is requiring ongoing medication to help control the rate
- Atrial fibrillation is very common in postoperative patients and should be verified as a complication before coding as such
- When multiple types of atrial fibrillation are documented in the record select the most specific type
There are other examples of how to code atrial fibrillation when multiple types are documented in the latest issue of Coding Clinic for ICD-10-CM/PCS, Second Quarter 2019: Page 3.
mayoclinic.org/diseases-conditions/atrial-fibrillation/symptoms-causes/syc-20350624Coding Clinic for ICD-10-CM/PCS, Second Quarter 2019: Page 3
Coding Clinic for ICD-10-CM/PCS, Third Quarter 2018: Page 6
Coding Clinic, Fourth Quarter 2013 Page: 11 & 98
Coding Clinic, Third Quarter 1995 Page: 8
The information contained in this coding advice is valid at the time of posting. Viewers are encouraged to research subsequent official guidance in the areas associated with the topic as they can change rapidly.
In Parts 1, 2 and 3 we learned about what sepsis is, sequencing of sepsis and what documentation is needed to report severe sepsis. In Part 4, we will look at clinical indicators needed to clinically support the diagnosis of sepsis and determine if a query is indicated.
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In Part 2 of our Sepsis Series, we are going to focus on sequencing of sepsis when the diagnosis is clearly documented. Later in the series we will look at what to do when the diagnosis is not clearly documented.
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In the previous two parts of this four part series, we discussed the new ICD-10-CM diagnosis code changes and ICD-10-PC procedure code changes. In this session we will review the major IPPS changes for FY2020. On August 2, 2019, CMS published the Final Rule for IPPS (CMS-1716) FY2020 IPPS Final Rule.
In Part 1 of this 4 part series we discussed some of the new ICD-10-CM diagnosis changes. In Part 2 we present the significant ICD-10-PCS procedure code changes. There are 72,184 total ICD-10-CM codes for FY2020.
This is Part 1 of a 4 part series on the FY2020 changes to ICD-10 and the IPPS. In this part, we discuss some of the new ICD-10-CM diagnosis changes. There are 72,184 total ICD-10-CM codes for FY2020.
We have finished with the step-by-step coding tidbits on coding of spinal fusions. If you were not able to catch Parts 1-13 of this series focused on spinal fusions, please visit hiacode.com/topics/series/spinal-fusion-coding/.
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This past year, HIA implemented “Buddy Up,” a program designed to help the new hire have a smooth transition into their new HIA roles with the assistance of a “buddy.” What is a Buddy? The Buddy is simply a peer who can guide the new hire in order to make them feel more comfortable. We are very proud of this program and have many success stories that we would like to share. Take a look at the wonderful feedback we have received below.
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Part 3: Spinal Fusion Coding — Determine the Level(s) or Region of Fusion and Number of Vertebrae Fused
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