Partnership Guide 2023Atrial Fibrillation

For an on-demand webinar, click here or navigate to MedicareProviders.Cigna.com > Provider Education > Disease-Specific Training.DefinitionThis common heart arrhythmia is a chronic condition that should include complete documentation that describes the type of atrial fibrillation and how it is being treated. Add chart/featured information here. Each conditions will have an “Essentials” section that will feature important information for coding that condition.img1Diagnostic statement should include applicable classification. The more descriptive terms are preferred over a simple diagnosis of atrial fibrillation.

Paroxysmal – episodes of AF of any duration and frequency spontaneously returning to sinus rhythm within seven days.

Persistent – AF lasting more than one week but less than one year, or requiring intervention to return to and/or maintain sinus rhythm.

Long-standing persistent - AF of longer than a year’s duration in a patient who remains a candidate for intervention to return to and/or maintain sinus rhythm, or remains a candidate for other rhythm control interventions.

Permanent (chronic) – AF of longer than a year’s duration in a patient who is no longer a candidate for return to sinus rhythm or other rhythm control interventions.

Documentation and codingDocument findings that support the diagnosis of AF. Documentation should be unique to each patient. These are examples of the type of documentation that would support Atrial Fibrillation.

A chronic disease, such as AF, must have a valid treatment plan to be considered an active medical problem. Treatment plans can be in the form of:

Medication
Referral
Diet
Monitoring
And/or ordering a diagnostic exam

Common treatment modalities include:

Medications such as beta blockers, calcium channel blockers, anti-arrhythmics, and anticoagulants to reduce stroke burden
Procedures such as direct current cardioversion with or without trans-esophageal guidance and catheter-based ablation

Document diagnostic statements that are compatible with the ICD-10 nomenclature

img2Subjective documentation considerationsDocument all applicable symptoms

Palpitations

Tachycardia

Fatigue

Weakness

Dizziness, lightheadedness

Shortness of breath, dyspnea at rest

Chest pain

Note: Not all patients with AF have symptoms.Document risk factors determined to be clinically relevant to the A-Fib

Coronary artery disease

Congestive heart failure

Hypertension

Diabetes

Chronic obstructive pulmonary disease

Prior atrial dysrhythmia

Open heart surgery

Hyperthyroidism

Advanced age

Obesity

Alcohol dependence

Sepsis

Electrolyte disturbances

Enlarged atrial chambers of the heart determined on echocardiogram

Objective documentation considerationsDocument all applicable exam, laboratory, and imaging findings

Irregularly irregular pulse

Edema

Jugular vein distention

Diagnostic testing to adjudicate the diagnosis

12-lead electrocardiogram
Echocardiogram, transthoracic and/or transesophageal
Laboratory test results relating to any underlying thyroid dysfunction, anemia, infection, and/or electrolyte or glucose abnormalities
Ambulatory cardiac monitoring

ICD-10 diagnostic codesimg3Note: If patient is on chronic anticoagulant therapy, add long-term (current) use of anticoagulants (Z79.01).Examples*Diagnostic statement: persistent atrial fibrillationCoded as: I48.91 Other persistent atrial fibrillationDiagnostic statement: atrial fibrillationCoded as: I48.91 Unspecified atrial fibrillationNote: Best practice is to avoid the use of unspecified codes by thoroughly documenting condition*The sole purpose of the examples is to demonstrate the application of coding guidelines discussed in the materials. Examples do not represent complete documentation of a condition, nor provide any clinical advice. Each patient and medical record is unique, and assignment of codes depends solely on the distinct documentation within an individual record.Providers must confirm the accuracy of their diagnoses to ensure that diagnosis and coding practices comply with ICD-10-CM Official Guidelines for Coding and Reporting and all applicable legal requirements. Failure to address diagnosis inaccuracies can result in administrative sanctions and potential financial penalties. Accurate coding and submission activities allow us to provide the best benefits and resources possible to our customers.This guide is informational and not meant to replace the clinician’s judgment when caring for the patient. Content updated April 20232023 Medicare Advantage Partnership GuideWelcomeContentsDocumentation Best Practices2023 Medicare Advantage ICD-10-CM Quick Reference Code GuideDisease-Specific Webinar LinksConditioning Reporting GuideReporting Common ConditionsAtrial FibrillationCancerChronic Kidney Disease (CKD)Chronic Obstructive Pulmonary Disease (COPD)Congestive Heart Failure (CHF)DVT and PEDementiaDiabetes Mellitus (DM)Major DepressionObesityPeripheral Artery Disease (PAD)Substance Use/Abuse/DependenceTobacco and E-Cigarette Use/AbuseSocial Determinants of Health