Monday, February 10, 2020

Atrial Fibrillation

This In the kNOW” discussion will focus on the condition often shortened in medicine as a-fib or AF, but in actuality termed atrial fibrillation.  This condition is a type of cardiac arrhythmia affecting the atria or upper chambers of the heart.  Rather than pumping effectively, in patients with a-fib, the atria quiver and the heart is ineffective in moving blood out to the body.  When blood pools or collects in the heart, clots may form and therefore, patients with atrial fibrillation are at a high risk for strokes.
The symptomatology for atrial fibrillation is quite variable. Patients may experience dizziness, shortness of breath, rapid heartbeat, a fluttering sensation in the chest, overall fatigue, and even chest pain.  However, there are individuals with a-fib who do not exhibit any symptoms with the condition discovered on a routine physical exam.         

Risk factors for atrial fibrillation include underlying heart problems such as cardiomyopathy or valve issues.  Other chronic conditions such as hypertension, diabetes, hyperthyroidism, and asthma can all increase the risk of atrial fibrillation as does age, as an individual’s risk increases with age. Surprisingly, athletes, who we tend to think of as being in good physical condition, are at risk as they may have a type of rapid heartbeat known as supraventricular tachycardia, which can trigger a-fib.  Excessive alcohol consumption can also precipitate a-fib.  Finally, atrial fibrillation is a very common postoperative complication.

The treatments available for a-fib range from medication and lifestyle changes, to a variety of procedures, such as cardioversion, insertion of pacemakers, or electrophysiological ablation.

There are several different types of atrial fibrillation, and this year, the ICD-10-CM update makes some changes to the coding of this condition.  Let’s look at the different types of atrial fibrillation before exploring the coding changes.

Paroxysmal atrial fibrillation – generally lasts less than a week, may resolve on its own

Persistent atrial fibrillation – lasts longer than a week, may require medication or cardioversion treatment

Long-Standing Persistent atrial fibrillation – lasts more than a year, treatment with ablation may be necessary

Permanent (Chronic) atrial fibrillation – this type of atrial fibrillation is generally not correctable

Postoperative atrial fibrillation – occurs after a surgical procedure, medication is likely treatment

Acute Onset atrial fibrillation – occurs suddenly and generally resolves within a day or two

Coding professionals may often see the term “rapid ventricular response” or RVR noted alongside a diagnosis of atrial fibrillation.  This term indicates that the irregularity of the atria have affected the ventricles or lower heart chambers.  This results in the ventricles beating too fast.  RVR does not impact the assignment of the atrial fibrillation code as clarified in a Coding Clinic from 3rd Qtr. 2018.  Coders should assign the code for the type of atrial fibrillation documented by the physician.
Here is a comparison of the Alphabetic Index for atrial fibrillation from 2019 to 2020.  Coders can identify the changes at a glance.  While unspecified and paroxysmal atrial fibrillation codes remain the same, the codes for chronic, persistent, and permanent underwent changes with the additions of fifth digits.  


Now you are In the kNOW!!

About the Author 

Dianna Foley, RHIA, CHPS, CCS  is OHIMA's Coding Education Coordinator. Dianna has been an HIM professional for 20 years. She progressed through the ranks of coder, department supervisor, and department director, to her current role as a coding consultant. 

She recently served as the program director for Medical Coding and HIT at Eastern Gateway Community College. Dianna earned her bachelor's degree from the University of Cincinnati subsequently achieving her RHIA, CHPS, and CCS certifications. She is an AHIMA Approved ICD-10-CM/PCS Trainer and a a presenter at regional HIM meetings and the OHIMA Annual Meeting.