Cardiology Coding Alert

Caution: Confusing persistent with permanent will lead you to the wrong code.

Atrial fibrillation encounters take billions out of the Medicare coffers, and with the population aging, costs are likely to increase. Be sure your claims stand up to scrutiny whether you're coding visits now or once ICD-10 is implemented in 2014.

Diagnosis: Atrial fibrillation is an irregular heart beat in which the heart's two upper chambers (the atria) beat chaotically (twitching). Atrial flutter is similar in that it refers to an irregular heartbeat involving the atria, but a flutter is a rapid pulsation that is well-organized (regular).

ICD-9-CM Codes

• 427.31, Atrial fibrillation
• 427.32, Atrial flutter

ICD-10-CM Codes

• I48.0, Paroxysmal atrial fibrillation
• I48.1, Persistent atrial fibrillation
• I48.2, Chronic atrial fibrillation
• I48.3, Typical atrial flutter
• I48.4, Atypical atrial flutter
• I48.91, Unspecified atrial fibrillation
• I48.92, Unspecified atrial flutter

ICD-9 coding rules: ICD-9 offers one code for atrial fibrillation and another for flutter.

ICD-10 changes: ICD-10 more than triples your options with more specific codes featuring terms such as paroxysmal, chronic, persistent, typical, and atypical. If you can't get the information needed to choose among those terms, you'll have "unspecified" options I48.91 and I48.92. Note that I48.1 is defined as "persistent atrial fibrillation," but CMS GEMs map I48.1 back to ICD-9 atrial flutter code 427.32.

Documentation: Be sure to share the expanded list of diagnosis definitions with your physicians as part of your ICD-10 implementation plan. Inclusion notes are important, too, as ICD-10 includes permanent atrial fibrillation under I48.2, Type I atrial flutter under I48.3, and Type II atrial flutter under I48.4.The more physician documentation lines up with code definitions, the faster you can complete and submit claims.

Coder tips: Providers use a variety of abbreviations for atrial fibrillation and flutter. You may see AFib or A-fib for atrial fibrillation. Atrial flutter may be abbreviated as AFL, A-FLUT, or A-flutter. One troublemaker is AF -- one provider may use this for atrial fibrillation while another may use it for atrial flutter. If your providers choose to use abbreviations, be sure they use ones that won't cause confusion or doubt. Auditors will want to see clear documentation to support code choice.

Remember: CMS has finalized the ICD-10 compliance date of Oct. 1, 2014. When ICD-10-CM goes into effect, you should apply the code set and official guidelines in effect for the date of service reported. Learn more at www.cms.gov/ICD10/ and www.cdc.gov/nchs/icd/icd10cm.htm#10update.