Postop atrial fib
Hi-how are you handling atrial fib that develops postop in thoracotomy patients? We code the atrial fib, obviously, but I'm wondering about classifying it as a postop complication. According to studies I have read, the incidence is likely about 10% and it does usually increase LOS. (I would have thought it was higher remembering my days caring for thoracotomy patients.) I found a code I97.89 postprocedural complications and disorders of circulatory system, NEC. Would you need to query for a postop complication to use this code?
Cathy
Cathy
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This is the reference I use
Post-Operative Atrial Fibrillation
Determining whether or not to view post-operative atrial fibrillation as a complication has several defining factors. First, does the patient have a history of atrial fibrillation that is currently being treated? If so, then post-operative atrial fibrillation is not a complication of surgery and was present on admission. Next, if a patient develops atrial fibrillation post-operatively, what was the outcome? If the patient had several beats of atrial fibrillation noted on cardiac monitoring that resolved on its own without treatment, this should not be considered a complication. On the other hand, if the post-operative atrial fibrillation required treatment, either with medications or defibrillation, this condition should be considered a complication.
One area that varies among physicians is post-operative atrial fibrillation following cardiac surgery. Some will agree that it is a complication, while others will say it is an expected outcome of the cardiac procedure. In these instances, the provider should be queried for clarification that the post-operative atrial fibrillation was, in fact, a complication. ICD-9-CM coding allowed for post-operative atrial fibrillation to be coded as a complication, with supporting language in the Coding Clinic published for the fourth quarter of 2013. This guidance is not so in ICD-10-CM. The physician has to specifically document that the post-operative atrial fibrillation is a complication of the procedure. Let’s assume documentation of post-operative paroxysmal atrial fibrillation. This would code: Fibrillation> atrial > paroxysmal. The ICD-10-CM code would be I48.0 (paroxysmal atrial fibrillation). Now, let’s assume that the provider documented that the “post-operative course is complicated by paroxysmal atrial fibrillation requiring amiodarone drip.” This would code: Fibrillation > atrial > postoperative complication > paroxysmal. ICD-10-CM codes would be I97.89 (other post-procedural complications and disorders of the circulatory system, not elsewhere classified) and I48.0 (paroxysmal atrial fibrillation) based on the instructional note to use an additional code to specify the disorder.
Check out:Classification of Surgical Complications Annals of Surgery • Volume 240, Number 2, August 2004.
To me this article it is still relevant today as there still is a lack of consensus in the surgical community on how to define complications. This shortcoming hampers comparison of outcome data among different centers and possibly progress in the surgical field .
From a clinical perspective, we had 30%+ incidence of atrial fib status post CABG..and some times even a higher rate with open valve procedures. Clinically we considered the incidence high enough to be considered an expected outcome. All patient's were informed of the strong possibility of this and there were standard protocols in place to deal with it (we didn't even have to call the doctors when it happened in many cases). We did not consider it a surgical misadventure, an indication of poor care, or an avoidable event. It just happens and at a high rate.
Take that for what you will. I did not try and add this as a complication and when working with physicians I would stress that they should just report "atrial fib" and not "post op atrial fib" unless they really wanted to report that they absolutely knew this was an unusual case that the I97 "post procedureal complication" reporting was APPROPRIATE for.