Since the “natural” tendency of atrial fibrillation is to cause a rapid heartbeat (i.e., atrial fibrillation with a rapid ventricular response), we use medication like beta blockers or calcium channel blockers to try to control the rate. If it lasts for a long time (i.e., more than 12 months), we call it longstanding persistent atrial fibrillation. This is called persistent atrial fibrillation. Sometimes it comes and persists until medical care coaxes the heart back into a normal rhythm with medication or electricity. This is known as paroxysmal atrial fibrillation. Sometimes it easily or spontaneously converts back to a normal sinus rhythm, usually within 48 hours. This causes the ventricles to contract at irregular intervals, usually rapidly unless a patient has medication on board to slow down the rate. The chaotic electrical signals cause a disordered, ineffective muscular movement of the atrium and unpredictable propulsion of the electrical signal. It is caused by dysfunction of the heart’s electrical system, with risk factors such as advanced age, genetic predisposition, structural and valvular heart disease, hypertension, alcohol, lung and thyroid disease. Atrial fibrillation is a dysrhythmia which occurs when the sinus node is no longer sending out regular impulses for a rhythmic contraction of the heart muscle. I believe the answer revealed a lack of understanding of the clinical situation. The submitted question regarded a patient who was on antiarrhythmic drugs for atrial fibrillation and the provider documented, “Chronic persistent atrial fibrillation.” The question posed was, “should I48.1, persistent atrial fibrillation or I48.2, chronic atrial fibrillation be coded?” The answer was to use persistent atrial fibrillation because it is a more specific code.

My objection, though, is that the explanation for the coding advice is not clinically sound.

Fortunately, after October 2019, the advice will be nullified anyway. I reviewed the Coding Clinic from Second Quarter and disagree with the reasoning for the first question regarding atrial fibrillation, although I do not have a problem with their solution. The author shares her thoughts on atrial fibrillation in the AHA Q2 Coding Clinic.

Chronic atrial flutter icd 10 code