Symptoms, Causes and Reporting of Atrial Fibrillation

Hello and welcome to our podcast series!

My name is Meghann Drella and I am a Senior Solutions Manager here at Outsource Strategies International. Today I will be discussing how to report Atrial Fibrillation.

It is the most common arrhythmia encountered in the critical care environment. It is caused by problems with the heart’s electrical system. A-fib can lead to longer ICU stay and is associated with an increased risk of mortality. The American Heart Association estimates that about 2.7 million Americans are living with A-fib. Effective October 1, 2019, ICD-10 category 148 Atrial fibrillation has been expanded from four codes to include more specific options for persistent and chronic atrial fibrillation.

Atrial fibrillation is an irregular and often abnormally fast heartbeat that can lead to blood clots, stroke, heart failure and other heart-related complications. Normally, the heart contracts and relaxes to a regular beat (between 60 and 100 beats a minute) when the person is resting. In A-fib, the upper chambers of the heart beat irregularly and sometimes at a very fast pace, and can be much higher than 100 beats a minute.

A-fib is widespread among older patients admitted to ICU with chronic conditions who are at risk for critical illness. New-onset AF has been found to be a common complication after cardiac surgery and also occurs among critically ill patients with a high incidence of renal failure and sepsis.

Atrial fibrillation can exist without any symptoms and remain undetected until the person has a medical check-up. The common signs and symptoms of atrial fibrillation are:

• Palpitations
• Dizziness
• Shortness of breath
• Fatigue
• Weakness
• Reduced ability to exercise
• Lightheadedness and
• Chest pain

Atrial fibrillation can cause blood clots, stroke, hypotension, and heart failure with subsequent organ dysfunction.

The exact causes of atrial fibrillation are unknown, but it is generally considered the result of high blood pressure and coronary artery disease. Conditions that increase risk of developing A-fib include:

• Age
• Hypertension
• Underlying heart disease and conditions
• Family history
• Sleep apnea
• Thyroid disease
• Diabetes
• Asthma
• Chronic kidney disease
• Previous heart surgery
• Viral infections
• Obesity
• Stress due to surgery
• Exposure to stimulants
• Sick sinus syndrome and
• Drinking alcohol

Since there are different types of arrhythmias, testing using an electrocardiogram (ECG/EKG), Holter monitor, event recorder, or echocardiogram may be ordered to enable correct diagnosis. Identifying atrial fibrillation type will facilitate proper treatment planning.

In 2020, ICD-10 added new codes for chronic, permanent, persistent, and long-standing permanent AF, all of which are co-morbidities/complications. In an inpatient setting, persistent atrial fibrillation needs to be reported as a confirmed diagnosis.  A Nov 2019 ACP Hospitalist article discussed key points about using the new ICD-10 codes for chronic atrial fibrillation.

The codes assigned should support medical necessity. Test reports may provide details about a diagnosis not included in the ordering provider’s documentation. In this case, a higher specificity code to support that diagnosis can be reported only if the ordering physician reviewed the results of the test and stated that he/she agreed with the findings.

I hope this helps but always remember that documentation as well as a thorough knowledge of payer regulations and guidelines is critical to ensure accurate reimbursement for the procedures performed.

Thank you for joining me and please stay tuned for my next podcast!