Atrial Fibrillation
Good morning,
We are working on becoming more consistent with query for specificity of A Fib (persistent, paroxysmal, chronic etc). Most of my attendings feel that "with RVR" is as specific as it gets, so lots of room to educate. The question that has come up most recently is the New Onset A Fib. I understand that payors are cracking down on unspecified codes for pdx), and yet new onset a fib is sometimes the pdx: using persistent, paroxysmal, chronic,etc often are not appropriate choices. How are you all handling this one?
We are working on becoming more consistent with query for specificity of A Fib (persistent, paroxysmal, chronic etc). Most of my attendings feel that "with RVR" is as specific as it gets, so lots of room to educate. The question that has come up most recently is the New Onset A Fib. I understand that payors are cracking down on unspecified codes for pdx), and yet new onset a fib is sometimes the pdx: using persistent, paroxysmal, chronic,etc often are not appropriate choices. How are you all handling this one?
Comments
Please clarify the new onset Atrial Fibrillation
Classification
Clinical AF is defined as an episode that lasts longer than 30 seconds. Lone AF refers to AF in patients younger than 60 years without coexisting heart disease. Following initial presentation,
AF can be categorized as:
• Paroxysmal AF—episodes of AF terminating spontaneously within 7 days or cardioverted within 48 hours of onset
• Persistent AF—episodes of AF lasting greater than 7 days or cardioverted after 48 hours of onset
• Longstanding persistent AF— continuous AF of greater than 12 months’ duration
• Permanent AF—restoration and maintenance of sinus rhythm has either failed or a decision has been made to not attempt rhythm control (refers to patients for whom a decision has been made not to restore or maintain sinus rhythm by any means, including catheter or surgical ablation)
Ref :Zipes Cardiac Electrophysiology: From Cell to Bedside
Chapter 75
Copyright © 2014,
But all readmissions for up to a year or as long as the MD is actively trying to convert a fib, is modifying the medication regimen, has scheduled cardiologist consults for it, has EPS studies or planned procedures such as ablation etc. then it would continue to be classified as "persistent". It becomes chronic when the patient and family agree to focus on chronic rate control and anticoagulation and "live with it". The time frame and treatment matters.
2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Patient Selection, Procedural Techniques, Patient Management and Follow-up, Definitions, Endpoints, and Research Trial Design
I actually would like it if we got some direction from the cooperating parties since they insist on giving us ICD 10 codes which our physicians often don't have definitions for. Write to them!
Having said that, I largely agree with the criteria above and this is an are where we recommend taking the criteria to your cardiologists at your hospital and working out what criteria will be official designated for your facility, until such time that the guidance is updated with some definitions that is.
I don't often see the long standing permanent strategy used, but I think it would be completely appropriate for situations where active treatment is still under way, even if that active treatment comes in the form of visits to the doctors office and continued testing and treatment (which may not be actively going on during an admission but would still put it into that category).