Cardiology Coding Alert

Tip: Physicians should document atrial flutter as either typical or atypical.

To code properly, you can't confuse terms like atrial fibrillation and atrial flutter - both types of an abnormal heart rhythm (arrhythmia). Although they share similarities, ICD-10 designates specific codes for both atrial fibrillation and atrial flutter.

Read more to learn about the differences between atrial fibrillation and atrial flutter and to see your ICD-10 options for each.

Understand Definition of Arrhythmia for Clarity

An arrhythmia causes a patient's heart to either beat too quickly (tachycardia) or too slowly (bradycardia). There are two types of arrhythmias: ventricular (in the ventricles, the lower chambers of the heart) and supraventricular (above the ventricles, such as in the upper chambers of the heart).

Atrial fibrillation and atrial flutter are two kinds of supraventricular arrhythmias.

To see the link atrial fibrillation and atrial flutter have with the natural pacemaker of the heart, look to this explanation from Julie Graham, BA, CPC, CCC, consultant at JG Cardiology and CT Consultingin Dallas, Texas.

"The heart is quite amazing, working continually to move blood through our body via a conduction system," says Graham. "This electrical system, the sinoatrial or SA node (nature's pacemaker) ensures proper contraction of the atria and ventricles at the right time, generating an impulse of the normal 60-100 bpm [beats per minute]."

But, with atrial fibrillation and atrial flutter, the SA node is disrupted, according to Graham.

"Atrial fibrillation and atrial flutter are two conditions in which we see our natural pacemaker get off track, so-to-speak," says Graham. "In both atrial fibrillation and atrial flutter, we see the atria beat faster than the ventricles."

Know Atrial Fibrillation Signifies Fast, Irregular

With atrial fibrillation, the atria quiver or fibrillate rather than beating normally.

"When we examine atrial fibrillation, we see the electrical pulse does not begin in the heart's natural pacemaker, the SA node," according to Graham. "Rather, it is a very disorganized signal triggered in other areas."

Your ICD-10 options for atrial fibrillation are as follows:

• I48.0, Paroxysmal atrial fibrillation
• I48.1, Persistent atrial fibrillation
• I48.2, Chronic atrial fibrillation
• I48.91, Unspecified atrial fibrillation.

Physician documentation tips: It's essential for physicians to document if the atrial fibrillation is paroxysmal, persistent, or chronic, if known, says Michelle Reese, CPC, CRC, CMQP, engagement director of healthcare at CliftonLarsonAllen LLP in Charlotte, N.C.

While your atrial fibrillation coding should always be based on your physician's documentation of type, here are some general guidelines regarding the differences among paroxysmal, persistent, and chronic atrial fibrillation:

Paroxysmal is defined as recurrent (at least one episode, greater than or equal to 30 seconds in duration) atrial fibrillation that terminates spontaneously within seven days, says Reese. Coders may also see this documented as "intermittent," adds Graham.

Persistent is defined as atrial fibrillation that is sustained and necessitates pharmacologic or electrical cardioversion to stop, according to Reese. You'll find definitions typically refer to persistent atrial fibrillation lasting more than one week.

Chronic is defined as continuous atrial fibrillation (greater than one year in duration), says Reese. Coders may also see this documented as "permanent," adds Graham. An inclusion note in the ICD-10 manual includes permanent atrial fibrillation under chronic code I48.2.

Learn Atrial Flutter Equals Fast, With Pattern

When a patient has an atrial flutter, rapidly fired signals make the muscles in the atria contract quickly, which leads to a fast, steady heartbeat, according to the American Heart Association (AHA).

"In contrast to atrial fibrillation, the electrical impulse in atrial flutter is more coordinated, thus creating an organized circular motion," says Graham.

Your ICD-10 options for atrial flutter are as follows:

• I48.3, Typical atrial flutter
• I48.4, Atypical atrial flutter
• I48.92, Unspecified atrial flutter.

Important: Inclusion notes in the ICD-10 manual includes type I atrial flutter under typical type I48.3 and type II atrial flutter under atypical type I48.4.

Physician documentation tip: Physicians should document the atrial flutter as either typical or atypical, according to Reese. And be sure to specify atrial flutter instead of fibrillation.

Ace Abbreviations for Atrial Fibrillation and Atrial Flutter

When it comes to the abbreviations physicians commonly use in documentation for atrial fibrillation and atrial flutter, you will usually see atrial fibrillation as "AFib," and atrial flutter as "AF," says Graham.

However, Graham cautions coders not to assume atrial fibrillation or atrial flutter when they see the abbreviation "AF" within the documentation.

"Query your physician if unsure," says Graham. "This could also be an opportunity to speak with your physician and discuss how he will document these for quick recognition and to be certain you're both on the same page."

Reese recommends that physicians abbreviate atrial fibrillation only as AFib and atrial flutter as Aflutter or Aflut.

The use of just "AF" as an abbreviation, without previously stating if the patient has either AFib or Aflutter, could cause problems, according to Reese.

"What is the exact condition? Is it atrial fibrillation or is it atrial flutter?" says Reese. "Or could it even be athlete's foot or anal fissure? 'AF' alone is not enough to determine."