Thank you for reviewing the AFib Ablation Registry Monthly Case Scenario for October 2020. This month's case scenario is focused on Sequence 4410 and 4415, Attempt at Atrial Fibrillation Termination and Pharmacologic Cardioversion. We have documentation of a patient being admitted for an AFib Ablation procedure. During the admission process of history and pre-procedure assessment, it is documented that that patient takes amiodarone 400 mg daily by mouth for the purpose of rate control. The patient verbally confirms documentation and states last dose was taken approximately 23 hours ago. Patient has no history of a direct current cardioversion or AFib Ablation procedure in the past. When abstracting the procedure, is it safe to assume that because the patient is taking amiodarone, which is a level 3 antiarrhythmic, an attempt to pharmacologically cardiovert the patient took place? Based on the documentation available, how will we code Sequence 4410, Attempt at Atrial Fibrillation Termination, and Sequence 4415, Pharmacologic Cardioversion? Yes or no? Please review the documentation in question to determine the best answer. We will give you a few seconds to review. The answer is No. Sequence 4410, Attempt at Atrial Fibrillation Termination, will be coded No as there is no documentation an attempt to terminate AFib ever took place. If Sequence 4410 is coded as No, Sequence 4415 to 4430, Pharmacologic Cardioversion DC Cardioversion, and Catheter Ablation will not need to be coded as these sequences only need to be coded when Sequence 4410 is coded Yes. Sequence 4415, Pharmacologic Cardioversion, will be coded only if there is specific documentation the antiarrhythmic medication was used for the purpose of cardioversion. If the patient is currently taking the medication in question on a daily basis, most likely the medication is being used for the purpose of rate control or maintaining a normal rhythm. Please only code Yes to Sequence 4415 or 4465, Atrial Fibrillation, Atrial Flutter Termination, and Pharmacologic Cardioversion when there is specific documentation that the medications mentioned were used for the purpose of cardioversion. For example, Ebola's in the ED due to AFib with RVR. If the patient is currently taking any of the medications listed in the patient's medical record on a daily basis, most likely the medications are being used for rate control or maintaining a normal rhythm. This applies to all antiarrhythmic medications, IV, as well as PO medications. Here are some examples. If the amiodarone was started as Ebola's, secondary to AFib, or an acute need to cardiovert, code as Yes. The initiation or admission for loading of a medication does not necessarily imply the medication was used for the purpose of a cardioversion. At times, they will admit the patient when starting a new medication. Be sure the documentation indicates it is for the purpose of cardioversion to code Yes. If there is documentation the patient was being treated with the pill-in-the-pocket or PRN approach, usually with flecainide or propafenone, and it can be determined that the patient took the medication for the purpose of attempting cardioversion, please code Yes to sequence 4415 or 4465, pharmacologic cardioversion. What we would like to capture in these sequences is an attempt for an immediate acute cardioversion using a pharmacologic agent. Thank you for reviewing the AFib Ablation Registry Monthly Case Scenario for October 2020.

AFib Ablation Registry

patient admission

AFib Ablation procedure

amiodarone

rate control