Atrial Fibrillation – Types, Symptoms and Medical Codes

1. Atrial Fibrillation – Types, Symptoms and Medical Codes Atrial fibrillation is an irregular heartbeat or arrhythmia that can lead to blood clots or other conditions. The article discusses the condition in detail along with the medical codes. www.outsourcestrategies.com 918-221-7769 Outsource Strategies International United States

2. Atrial fibrillation (AFib or AF) refers to quivering or irregular heartbeat (arrhythmia) that can directly interrupt the normal flow of blood resulting in blood clots, heart failure and other heart-related complications. The condition is characterized by a rapid and irregular heart beat caused when the upper chambers of the heart (the atria) quiver (fibrillate) erratically, at times faster than 200 times per minute. The heart condition can have a significant impact on a person’s quality of life, causing debilitating pain, heart palpitations, and chronic fatigue, thereby increasing the risk of stroke fivefold. Treatment for this condition includes medications and other interventions that attempt to alter the heart’s electrical system. As physicians focus on treatment, they can rely on an experienced medical billing and coding company to submit the correct ICD-10 diagnosis codes for clinical billing. An expert billing company can help physicians report different types of atrial fibrillation correctly. Regarded as one of the most commonly diagnosed cardiac rhythm disturbances, AFib is prevalent between 2.7 and 6.1 million people in the United States. It is estimated that people above the years of 65 years have higher chances of developing this condition. The exact cause of atrial fibrillation isn’t always known. The heart contains four chambers - two atria and two ventricles. Normally, the atria and ventricles contract at the same speed. However, in case of atrial fibrillation, the atria and ventricles are out of sync because the atria contract very quickly and irregularly. Other conditions that can cause damage to the heart and lead to AF include – high blood pressure, heart valve disease, congenital heart defects, thyroid disease, consumption of certain type of medications, obesity and binge drinking habits. Types of Atrial fibrillation (AFib) Atrial fibrillation may be – paroxysmal, persistent, long-standing persistent and permanent. Paroxysmal AFib – Also called occasional AFib, in this type, the irregular heart rhythm starts suddenly and resolves without treatment within 7 days. A person with this type of AFib will have no noticeable symptoms and may not require treatment to control their heart rhythm. Persistent AFib - The episodes in persistent AFib are continuous and last for more than 7 days. Medications or a special type of electrical www.outsourcestrategies.com 918-221-7769

3. shock (called cardioversion) is used to help the heart return to normal rhythm. Long-term persistent AFib– Formerly called permanent AFib, this type of irregular heart rhythm cannot be corrected and lasts longer than 12 months. Permanent - In this type, the abnormal heart rhythm cannot be restored. People will have atrial fibrillation permanently and often require medications to control heart rate and to prevent blood clots. What Symptoms Are Involved? In some cases, people with atrial fibrillation do not experience any specific types of symptoms and are quite unaware about the condition until it is discovered during a detailed physical examination. On the other hand, those who experience symptoms may notice – Heart palpitations (feeling like your heart is skipping a beat, beating too fast or hard, or fluttering) Weakness and dizziness Reduced ability to exercise Lightheadedness Fatigue Fainting Fluttering or “thumping” in the chest Shortness of breath and anxiety Chest pain Diagnosing and Treating Atrial fibrillation (AFib) Diagnosis of this cardiac disorder will begin with a detailed physical examination wherein the cardiologist or other specialists may conduct different diagnostic imaging tests such as Electrocardiogram (ECG), Echocardiogram, Chest X-ray, Event recorder, Holter monitor, stress test and other blood tests to analyze the degree of heart abnormality. Treatment may not be required for patients who don’t depict any specific symptoms, don’t suffer from other heart problems, or if the atrial fibrillation gets cured on its own. Normally, a combination of medications and other surgical procedures will be prescribed. Taking these medications for AFib will help normalize the heart rate and promote better heart function overall. In www.outsourcestrategies.com 918-221-7769

4. addition, these medicines will also prevent blood clots in the future, as well as reduce further complications such as heart attack and stroke. Depending on the patient’s condition, cardiologists may prescribe multiple AFib medications like - anti-arrhythmics such as Dofetilide (Tikosyn), Flecainide, Propafenone (Rythmol), Amiodarone (Betapace, Sorine) and Anticoagulants such as Warfarin (Coumadin, Jantoven) and Dabigatran (Pradaxa) as part of the treatment. Other treatment modalities include - Electrical cardioversion and other surgical procedures such as Catheter ablation, Atrioventricular (AV) node ablation, surgical maze procedure and Left atrial appendage closure. (Cordarone, Pacerone), Sotalol Medical billing and coding for chronic cardiac disorders like Atrial fibrillation (AFib) can be challenging. The process requires a clear understanding about the highly specific ICD-10 and CPT codes. Physicians can rely on the services of a reliable cardiology medical billing and coding company to submit claims for optimal reimbursement. The following medical codes are used – ICD-10 Codes for AFib In ICD-10-CM, the following codes are used to report atrial fibrillation - I48 – Atrial fibrillation and flutter 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 I48.9 – Unspecified atrial fibrillation and atrial flutter I48.91– Unspecified atrial fibrillation I48.92– Unspecified atrial flutter I49 – Other cardiac arrhythmias I49.0– Ventricular fibrillation and flutter I49.01– Ventricular fibrillation If the physician diagnoses the patient with chronic persistent atrial fibrillation only the code I48.1 (persistent atrial fibrillation) is reported. The term “chronic” is a nonspecific term that could also be used to describe the other types of specified atrial fibrillation. As the code - I48.1 is a more specific code this is the one that should be reported. Even though the Alphabetic Index within ICD-10-CM has listed the different types of atrial www.outsourcestrategies.com 918-221-7769

5. fibrillation at the same indention level, only one code need to be reported. The most specific term should be reported. CPT Codes 93650– Intracardiac catheter ablation of atrioventricular node function, atrioventricular conduction for creation of complete heart block, with or without temporary pacemaker placement 93653– Comprehensive electrophysiologic insertion and repositioning of multiple electrode catheters with induction or attempted induction of an arrhythmia with right atrial pacing and recording, right ventricular pacing and recording (when necessary), and His bundle recording (when necessary) with intracardiac catheter ablation of arrhythmogenic focus; with treatment of supraventricular tachycardia by ablation of fast or slow atrioventricular pathway, accessory atrioventricular connection, cavo- tricuspid isthmus or other single atrial focus or source of atrial re-entry 93654– Comprehensive electrophysiologic insertion and repositioning of multiple electrode catheters with induction or attempted induction of an arrhythmia with right atrial pacing and recording, right ventricular pacing and recording (when necessary), and His bundle recording (when necessary) with intracardiac catheter ablation of arrhythmogenic focus; with treatment of ventricular tachycardia or focus of ventricular ectopy including intracardiac electrophysiologic 3D mapping, when performed, and left ventricular pacing and recording, when performed 93656– Comprehensive electrophysiologic transseptal catheterizations, insertion and repositioning of multiple electrode catheters with induction or attempted induction of an arrhythmia with atrial recording and pacing, when possible, right ventricular pacing and recording, His bundle recording with intracardiac catheter ablation of arrhythmogenic focus, with treatment of atrial fibrillation by ablation by pulmonary vein isolation 93655– Intracardiac catheter ablation of a discrete mechanism of arrhythmia which is distinct from the primary ablated mechanism, including repeat diagnostic maneuvers, to treat a spontaneous or induced arrhythmia (List separately in addition to code for primary procedure) evaluation including evaluation including evaluation including www.outsourcestrategies.com 918-221-7769

6. 93657– Additional linear or focal intracardiac catheter ablation of the left or right atrium for treatment of atrial fibrillation remaining after completion of pulmonary vein isolation (List separately in addition to code for primary procedure) 93613– Intracardiac electrophysiologic 3-dimensional mapping (List separately in addition to code for primary procedure) Most cases of atrial fibrillation can be effectively managed or treated. The most common complications of AFib are strokes and heart failure. By making serious lifestyle changes such as practicing regular body exercise, maintaining a healthy weight, avoiding smoking/ alcohol consumption, eating heart-healthy foods and keeping blood pressure and cholesterol levels under control can help reduce the risk of atrial fibrillation. Health officials have declared the month of September as “National Atrial Fibrillation (AFib) Awareness Month” in the United States. The annual observance serves as a perfect platform to raise awareness about this life threatening arrhythmia.Having correct knowledge about the ICD-10 and CPT codes related to this cardiac procedure is critical for cardiologists. Partnering with an experienced medical billing company is a great option for cardiologists to ensure accurate and timely claim submissions. www.outsourcestrategies.com 918-221-7769