MDS Alert

Hint: Knowing these particulars will make coding easier.

Atrial fibrillation and atrial flutter are both types of arrhythmia, or abnormal heart rhythm. You’re probably familiar with the terms already, but distinguishing the two is crucial to choosing the correct ICD-10 codes for any of your residents’ applicable heart conditions.

Make sure you have a firm grounding by understanding the differences between the two, as well as knowing what to look for in any physician documentation to make sure you apply the correct ICD-10 code.

Distinguish Between Various Arrhythmias

An arrhythmia causes a resident’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 Consulting in 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, Graham explains.

“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.”

Remember Fibrillation Suggests 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,” Graham says. “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; and
• 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, North Carolina.

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, Reese says. Coders may also see this documented as “intermittent,” Graham adds.
• Persistent is defined as atrial fibrillation that is sustained and necessitates pharmacologic or electrical cardioversion to stop, Reese explains. 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), Reese says. 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.

Atrial Flutter Signifies Fast and Patterned

When a resident 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,” Graham says.

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

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

Important: Inclusion notes in the ICD-10 manual include 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.

Master These Abbreviations

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,” Graham says.

However, Graham cautions that one should not assume atrial fibrillation or atrial flutter when seeing the abbreviation “AF” within the documentation.

“Query your physician if unsure,” Graham says. “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?” Reese says. “Or could it even be athlete’s foot or anal fissure? ‘AF’ alone is not enough to determine.”