Chronic AF with RVR

Patient with known history of atrial fibrillation on Diltiazem and Coumadin is admitted with atrial fibrillation with RVR with a HR of 150 BPM on arrival.  They were placed on a Diltiazem drip after no improvement in the HR after a dose of Diltiazem IVP and PO.  The Cardiologist documents that a review of all EKGs and rhythm strips dating back to 2015 reveal atrial fibrillation therefore her diagnosis is chronic atrial fibrillation. He also notes currently patients HR is predominately in the 90s and occasionally into the 80 -100s. Recommends weaning off the Diltiazem drip. 

Does the above documentation warrant a query to see if this paroxysmal atrial fibrillation in addition to chronic atrial fibrillation?


  • What  impact are you looking for by adding the paroxysmal a fib code to the chronic a fib?  What was the precipitating event for the RVR (resp compromise, stress, medication reactions etc.).

    Since they are not excludes 1s, they could technically be reported together. Since you are essentially reporting an acute and a chronic form of the condition at the same time, you could use paroxysmal as pdx. 

    Might help with medical necissity since chronic a fib would be a questionable admission as we don't admit patients for that usually. 

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