The TrustHCS education team provides regular in-service coding tips to our team of credentialed coding professionals. This month, chronic atrial fibrillation was highlighted. Compiling coding clinic information and various guidelines, the following covers the tips provided to the TrustHCS team. Coding clinics were recently published to clarify coding atrial fibrillation. Be on the lookout for changes to these codes effective October 1, 2019.

 

Chronic Persistent Atrial Fibrillation:
Coding Clinic for ICD-10-CM/PCS, Second Quarter 2019

 

Overall, based on the 2nd Quarter 2019 Coding Clinic, “Chronic” is a nonspecific term and would not be assigned if another type of atrial fibrillation is documented. Page 3 of the coding clinic covered “Chronic Persistent Atrial Fibrillation”. Coding advice or code assignments contained in this issue impacts discharges from and beyond June 21, 2019.

Review this question and answer pair as a sample application of this coding clinic concept.

QUESTION: A 68-year-old man with a history of hypertension, chronic obstructive pulmonary disease and coronary artery disease (CAD) was admitted to the hospital for evaluation of atrial fibrillation (AF). While in the hospital, the patient’s AF was controlled using antiarrhythmic drugs. The provider’s final diagnostic statement listed “Chronic persistent atrial fibrillation.” Since there are unique codes for both chronic and persistent atrial fibrillation, which code is more appropriate:

  • 1, Persistent atrial fibrillation
  • Or I48.2, Chronic atrial fibrillation

ANSWER: Assign only code I48.1, Persistent atrial fibrillation, as the principal diagnosis. Persistent AF is an abnormal heart rhythm that continues for seven days or longer, or that requires repeat electrical or pharmacological cardioversion. Chronic atrial fibrillation is a nonspecific term that could be referring to paroxysmal, persistent, long standing persistent, or permanent atrial fibrillation. Since code I48.2 is nonspecific, code I48.1 is a more appropriate code assignment. 

 

Chronic Atrial Fibrillation with Rapid Ventricular Response:
Coding Clinic for ICD-10-CM/PCS, Third Quarter 2018

 

Overall, based on page 6 of the 3rd Quarter 2018 Coding Clinic, “Chronic atrial fibrillation with rapid ventricular response (RVR)” should be coded to I48.2. Chronic atrial fibrillation and RVR would not be coded separately. RVR indicates a problem with rate control, not paroxysmal and should not be coded as paroxysmal. Coding advice or code assignments contained in this issue impacts discharges from and beyond September 24, 2018.

Review this question and answer pair as a sample application of this coding clinic concept.

QUESTION: A patient is admitted for treatment of chronic atrial fibrillation (AF) with rapid ventricular response (RVR). The classification provides codes that describe paroxysmal, chronic, and persistent atrial fibrillation, but not atrial fibrillation with rapid ventricular response. A diagnosis of chronic AF with RVR seems to indicate severity.

  • Would it be appropriate to assign code I48.0, Paroxysmal atrial fibrillation, for AF with RVR?
  • If not, what code should be assigned to reflect chronic atrial fibrillation with RVR?

ANSWER:  No, code I48.0 is not appropriate since the patient does not have paroxysmal atrial fibrillation. Assign code I48.2, Chronic atrial fibrillation, for chronic AF with RVR. The RVR is not coded separately. Chronic atrial fibrillation with rapid ventricular response (RVR) indicates problems with rate control, not paroxysmal atrial fibrillation. 

 

Subscribe to the TrustHCS blog for more coding tips like these!

 

References
ICD-10-CM/PCS Coding Clinic®, Third Quarter 2018 Page: 6
ICD-10-CM/PCS Coding Clinic®, Second Quarter 2019 Page: 3