ICD-10 Training for Skilled Nursing Facilities: Acing Arrhythmia Reporting

Posted on 18 Jun, 2019 |comments_icon 0|By Elizabeth Debeasi

Gear up for PDPM and get atrial fibrillation vs. atrial flutter right every time.

With an interest in knowing precisely why a resident ends up in a nursing facility, the Centers for Medicare and Medicaid Services (CMS) will implement the patient-driven payment model (PDPM) in just a few months. Unlike the current RUG-IV, this new case-mix classification model elevates documenting and coding your residents’ primary diagnoses to a key determinant of reimbursement.

But navigating the immense ICD-10-CM system, with diagnosis codes numbering in the tens of thousands, can feel overwhelming. That’s why we’ve been providing you with this monthly blog series, tackling the most prevalent skilled nursing facility (SNF) diagnoses one at a time to help ready your MDS coders for Oct. 1.

In today’s post, we simplify supraventricular arrhythmia reporting, equipping you to keep your claims on track for optimal pay. But you won’t want to miss recent ICD-10 posts written especially for your SNF, as these may prove invaluable to securing your hard-earned revenue for other prominent conditions:

Understanding Supraventricular Arrhythmias

An arrhythmia is an abnormal heart rhythm that causes a resident’s heart to beat too quickly (tachycardia) or too slowly (bradycardia). Depending on the origin of the arrhythmia, it may be classified as either:

  • Ventricular: involving the ventricles, or lower chambers of the heart, or
  • Supraventricular: occurring above the ventricles, in the atria, or upper chambers of the heart.

Under normal circumstances, the heart’s rhythm and rate is maintained by a natural pacemaker known as the sinoatrial (SA) node. The SA node sends out regular electrical impulses from the atria, causing them to contract and pump blood into the ventricles. The electrical impulse then travels to the ventricles through the atrioventricular (AV) node.

In cases of atrial fibrillation and atrial flutter, both types of supraventricular arrhythmias, the SA node is disrupted, causing the atria to beat faster than the ventricles.

While you’re probably familiar with these two terms, distinguishing atrial fibrillation from atrial flutter is crucial to choosing the correct ICD-10 code to represent your residents’ specific heart conditions.

Think ‘Fast & Irregular’ for Fibrillation

With atrial fibrillation, the electrical pulse doesn’t begin in the SA node but is triggered from other areas, sending a disorganized signal. As a result, the atria quiver or fibrillate rather than beating normally.

Your ICD-10 options for atrial fibrillation include the following choices:

  • I48.0, Paroxysmal atrial fibrillation
  • I48.1, Persistent atrial fibrillation
  • I48.2, Chronic atrial fibrillation
  • I48.91, Unspecified atrial fibrillation.

While you should base your atrial fibrillation coding on your physician’s documentation of type, these general guidelines may help you grasp the differences between paroxysmal, persistent, and chronic atrial fibrillation:

  • Paroxysmal atrial fibrillation is considered recurrent (at least one episode, greater than or equal to 30 seconds in duration) and terminates spontaneously within seven days. Documentation might note paroxysmal atrial fibrillation as “intermittent,” so be on the lookout.
  • Persistent atrial fibrillation refers to a sustained state (lasting longer than one week) that necessitates pharmacologic or electrical cardioversion to regain normal heart rhythm.
  • Chronic atrial fibrillation is defined as continuous (greater than one year in duration). This condition may be reported in documentation as “permanent,” and an inclusion note in the ICD-10 manual includes permanent atrial fibrillation under chronic code I48.2.

Ponder ‘Fast & Patterned’ for Flutter

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).

Unlike atrial fibrillation, the electrical impulse in atrial flutter is coordinated, which creates a patterned, or organized, arrhythmia.

Your ICD-10 options for atrial flutter are:

  • I48.3, Typical atrial flutter
  • I48.4, Atypical atrial flutter
  • 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. Physicians should document the atrial flutter as either typical or atypical.

Know Your Abbreviations

When it comes to abbreviations used by physicians to document atrial fibrillation and atrial flutter, you’ll often see atrial fibrillation noted as “AFib.” Sometimes, though, physicians may use “AF.” You can imagine the potential for confusion, as “AF” could also represent atrial flutter — or various other, unrelated diagnoses.

If you come across “AF,” be sure to confirm your interpretation with the physician. It would be wise, in fact, to establish clearly defined abbreviations for these conditions to ensure physicians and coders are on the same page. To avoid error, you might limit your options to these abbreviations:

  • AFib for atrial fibrillation
  • Aflutter or Aflut for atrial flutter.

Contributing editor: Rachel Dorrell

Learn More

Get your team up to speed with monthly ICD-10 coaching geared to your SNF patient population in your subscription to MDS Alert. This indispensable resource, trusted by post-acute providers for nearly 20 years, will equip you with walk-through guidance to prep for all facets of the PDPM.

Home in on accurate code selection with at-a-glance access to ICD-10-CM codes for the diagnoses common among SNF patients — and bank your deserved pay — with the Rapid Coder ICD-10 Chart for Skilled Nursing Facility, laminated front and back for maximum durability.

To receive practical ICD-10 training strategies, answers to your ICD-10 coding and ICD-10-CM coding guideline questions, as well as specific examples to help you apply ICD-10 coding fundamentals, check out TCI’s ICD-10 Coding Alert.


Elizabeth Debeasi
Marketing Writer/ Editor

Elizabeth works on an array of projects at TCI, researching and writing about modern reimbursement challenges. Since joining TCI in 2017, she has also covered the nuts and bolts of cybersecurity, compliance with federal laws, and how to tap into the advantages of Telehealth services.

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