Coding, Classification and Reimbursement

Coding Afib

  • 1.  Coding Afib

    Posted 11-30-2018 07:05
    ​If physician documents atrial fibrillation with rapid ventricular response can this be coded I48.0 paroxysmal atrial fibrillation or does the physician have to document it as paroxysmal?

    Tara Curley,RHIT
    Medical Coder

  • 2.  RE: Coding Afib

    Posted 11-30-2018 10:46
    I think you'd need documentation of paroxysmal for it to be I48.0. So in this instance you would use I48.91 (unspecified a-fib). For either code you would add I47.2 for ventricular tachycardia since there's no combination code and RVR isn't a "main " component; it only occurrs sometimes with a-fib.

    Blake Guillot, RHIT
    Medical Scribe

  • 3.  RE: Coding Afib

    Posted 12-01-2018 10:49

     Coding Clinic 3Q 2018 pg 6 [Chronic atrial fibrillation with rapid ventricular response] states the RVR (rapid ventricular response) is not coded separately.

    Karen Neal
    Coding Quality Auditor
    Conifer Health Solutions

  • 4.  RE: Coding Afib

    Posted 12-01-2018 04:34
    No you should query the provider for the type of AFIB

    Anugu Srinivas
    Medical Coder
    Bachelor of pharmacy,CCS

  • 5.  RE: Coding Afib

    Posted 12-02-2018 08:55
    Edited by Lawrence Barr 12-02-2018 08:59

    "Paroxysmal" is an essential modifier, so it should be specifically documented.  I know I read somewhere that "PAF" or other such abbreviations are not acceptable unless the term "paroxysmal" is documented somewhere in the record.  "PAF" could stand for "persistent" a. Fib.

    When the A fib is not specified, assign code I48.91, unless you are directed otherwise by your management.  A more specific code will not affect DRG assignment.  Most places do not query in such situations.

    Also, "RVR" is not the same as "ventricular tachycardia".  Do not assign additional code I47.2 for the RVR.

    Lawrence Barr

  • 6.  RE: Coding Afib

    Posted 12-06-2018 21:19
    Code aFib with RVR. The documentation seems clear.

    Olasunkanmi Peleowo

  • 7.  RE: Coding Afib

    Posted 12-07-2018 06:07
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    I48.0 is not correct. There is a coding clinic on this .....


    The correct code is chronic Afib I48.2.



    A patient is admitted for treatment of chronic atrial fibrillation (AF) with rapid ventricular response (RVR). The classification provides codes that describe paroxysmal, chronic, and persistent atrial fibrillation, but not atrial fibrillation with rapid ventricular response. A diagnosis of chronic AF with RVR seems to indicate severity. Would it be appropriate to assign code I48.0, Paroxysmal atrial fibrillation, for AF with RVR? If not, what code should be assigned to reflect chronic atrial fibrillation with RVR?


    No, code I48.0 is not appropriate since the patient does not have paroxysmal atrial fibrillation. Assign code I48.2, Chronic atrial fibrillation, for chronic AF with RVR. The RVR is not coded separately. Chronic atrial fibrillation with rapid ventricular response (RVR) indicates problems with rate control, not paroxysmal atrial fibrillation.



    Brenda Mohs, RHIT

    Home Health & LTC Medical Coder

    Essentia Health



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  • 8.  RE: Coding Afib

    Posted 12-08-2018 07:07
    You have to understand that under normal physiology electrical cardiac impulses( beats ) are conducted from the SA node in the Atrium to the left and right ventricles( simultaneously) and this is on one is to one ratio meaning one atrial beat to one ventricular beat ( ventricular response )..... any part in the atrium or/and any part of the ventricles is capable of initiating its own impulse although the ventricles produce impulses ( beat ) at a slower rate...... what happens during Atrial Fib  is several points/loci in the atrium generate impulses on its own altogether thus causing fibrillatory atrial beats.... some of these impulses cross the normal pathway to generate ventricular beats on a rapid fire thereby causing rapid ventricular response.... in some cases only a few atrial beats are conducted to the ventricles, so the ventricle becomes independent of the atrium and beat on its own at a slower rate thus causing a slow ventricular response .... clinical classification of AF ( paroxysmal, intermittent, persistent, permanent) is not dependent on the ventricular response but on a certain time period... Paroxysmal usually AF terminates within 7? days spontaneously or with meds, persistent is if it does not terminate spontaneously or despite treatment ( longer than 7? days )..and chronic is as the description ....
    I hope this helps

    Josefino Lim

  • 9.  RE: Coding Afib

    Posted 12-08-2018 09:24

    Correct code assignment is dependent upon the provider's documentation and application of coding rules as contained within the Classification Instructions, Official Guidelines and Coding Clinic advice.  The original question states the provider documented "atrial fibrillation with rapid ventricular response".   The atrial fibrillation is not qualified with an essential modifier.  In order to assign a code for either "paroxysmal" or "chronic" a. fib. one of those terms must be documented; they are essential modifiers.  As per the cited Coding Clinic, RVR associated with atrial fib is not coded separately.  The question in Coding Clinic specifically states "chronic atrial fibrillation".  In the current question the atrial fibrillation is unspecified.  Therefore, the default code I48.91 is assigned.  This can be found by first looking up the condition in the Alphabetic Index, checking the subentries for essential modifiers, looking up the appropriate entry in The Tabular List and checking for any applicable Instructional notes, Guidelines, and Coding Clinic references.

      - atrial or auricular (established) I48.91
        - - chronic I48.2
        - - paroxysmal I48.0
        - - permanent
         - - persistent I48.1

    Since the terms "chronic" and "paroxysmal" are both not contained within parentheses, they are essential modifiers and must be documented.  The default code is always the first one listed for the main entry.  Finding the code in The Tabular shows no applicable Instructional Notes and there are no applicable Official Guidelines.  Not assigning an additional code for RVR as per Coding Clinic has already been discussed.

    For the current case being discussed the correct code is I48.91, Atrial Fibrillation NOS.

    Lawrence Barr