September is National Atrial Fibrillation Awareness Month.
I saw a commercial the other day which caught my attention. It was either real people or actors saying they had experienced certain symptoms and, since “they didn’t wait” to tell their healthcare provider, their atrial fibrillation (Afib) had been promptly diagnosed and appropriately treated. I don’t recall if it was selling a medication or if it was a public service announcement, but if their goal was to make me aware of Afib, it would likely work (if I didn’t have such a strong family history, since I was a doctor, and already was keenly aware of it before).
Atrial fibrillation is a disordered electrical disturbance where the atria, the small compartments of the heart, stop beating in synchrony. It is described as the heart looking like a bag of worms. The erratic impulses cross over to the ventricles and are irregularly propagated causing irregular myocardial contractions. Unmedicated Afib is usually rapid and irregularly irregular (that is, without a discernible pattern).
Afib is the most common cardiac dysrhythmia, and by 2030, it is predicted there will be more than 12 million Americans living with it. Afib contributes to approximately 158,000 deaths yearly and that has been rising over the past few decades because life expectancy has been creeping up (until the last few years, of course, when COVID-19 has reversed that trend). The prevalence and incidence of Afib increase sharply after 65 years of age, and more than 10 percent of patients 85 years old or older have Afib.
Risk factors for Afib include advancing age, family history, obesity, smoking, alcohol use disorder, stress, and certain medical conditions like hypertension, diabetes, hyperthyroidism, heart disease including valvular disease and heart failure, and chronic kidney disease. The dysrhythmia can lead to blood clots in the heart, heart failure, other complications caused by decreased cardiac output, and the dreaded stroke.
Afib causes approximately 20 percent of strokes, although in patients over 80 years old, it is more like 1 in four strokes. It probably is associated with an even higher number because Afib itself increases the risk of ischemic embolic cerebrovascular accidents, but anticoagulation for Afib also results in hemorrhagic strokes, too.
There are typical signs and symptoms which are associated with Afib including heart palpitations, irregular heartbeat, fatigue, chest pain, shortness of breath, dizziness or lightheadedness, syncope, and hypotension. Patients may be asymptomatic and unaware that they are in Afib. Making the public aware of potential presentations of Afib is the goal of that commercial I mentioned at the beginning of this piece. If you, or someone you know, experiences any of these signs or symptoms, you should seek medical attention immediately, not pull an “I’ll tell my doctor about it when I see her next.”
In the emergency department, they would do an electrocardiogram to look at the heart rhythm, draw blood work to see if the patient had a heart attack, get a chest X-ray, and possibly have the patient undergo an echocardiogram. Treatment would be supportive initially to manage the heart rate, prevent complications, and possibly try to convert the patient into a normal cardiac rhythm.
New-onset Afib is what it sounds like. It is the first presentation of Afib, what type it will ultimately be is as yet undetermined. Paroxysmal Afib consists of usually short-lived, self-terminating episodes which recur sporadically.
Persistent Afib lasts longer than a week and requires intervention to cease. Management can consist of rate control, usually with beta blockers or calcium channel blockers; attempts to put the patient back into sinus rhythm, which can be done by electrical cardioversion, chemically with antiarrhythmics, or by surgical ablation; and anticoagulation to minimize the risk of stroke from intra-atrial clot.
If Afib continues for more than a year, it is deemed long-standing persistent. When a physician and patient decide cardioversion is no longer going to be an option, Afib is deemed permanent. The expression, chronic Afib includes both persistent and permanent Afib. Chronic, persistent, and permanent Afib are all comorbid conditions/complications (CCs). Paroxysmal and unspecified Afib are not.
Older, sicker hearts can develop slow heart rhythms and require pacemakers. If the underlying rhythm is slow atrial fibrillation, it would continue to be codable. These patients are often maintained on anticoagulation, too, so they would get a long-term anticoagulation use code as well.
I’m not sure it is appropriate to say, “Happy National Atrial Fibrillation Awareness Month,” but I will say it anyway. Be aware of Afib and do what you can to decrease your risk.
Modify your lifestyle to decrease your risk.
Quit smoking, control your weight, exercise, get enough sleep, limit your stress, and refrain from excessive alcohol and caffeine. Take your blood pressure, diabetes, and cholesterol-reducing medications as prescribed.
Happy National Atrial Fibrillation Awareness Month!
Programing note: Listen to Dr. Erica Remer every Tuesday when she cohosts Talk Ten Tuesdays with Chuck Buck.
Happy New Year. This holiday season provided me with the opportunity to catch up withsome of my former colleagues who helped shape my career in
Anyone who has worked within the scope of hospital case/utilization management for any period of time has heard of the Centers for Medicare & Medicaid
Please log in to your account to comment on this article.
Accurately determining the principal diagnosis is critical for compliant billing, appropriate reimbursement, and valid quality reporting — yet it remains one of the most subjective and error-prone areas in inpatient coding. In this expert-led session, Cheryl Ericson, RN, MS, CCDS, CDIP, demystifies the complexities of principal diagnosis assignment, bridging the gap between coding rules and clinical reality. Learn how to strengthen your organization’s coding accuracy, reduce denials, and ensure your documentation supports true medical necessity.
Denials continue to delay reimbursement, increase administrative burden, and threaten financial stability across healthcare organizations. This essential webcast tackles the root causes—rising payer scrutiny, fragmented workflows, inconsistent documentation, and underused analytics—and offers proven, data-driven strategies to prevent and overturn denials. Attendees will gain practical tools to strengthen documentation and coding accuracy, engage clinicians effectively, and leverage predictive analytics and AI to identify risks before they impact revenue. Through real-world case examples and actionable guidance, this session empowers coding, CDI, and revenue cycle professionals to shift from reactive appeals to proactive denial prevention and revenue protection.
Sepsis remains one of the most frequently denied and contested diagnoses, creating costly revenue loss and compliance risks. In this webcast, Angela Comfort, DBA, MBA, RHIA, CDIP, CCS, CCS-P, provides practical, real-world strategies to align documentation with coding guidelines, reconcile Sepsis-2 and Sepsis-3 definitions, and apply compliant queries. You’ll learn how to identify and address documentation gaps, strengthen provider engagement, and defend diagnoses against payer scrutiny—equipping you to protect reimbursement, improve SOI/ROM capture, and reduce audit vulnerability in this high-risk area.
Only ICD10monitor delivers what you need: updates on must-know changes associated with the FY26 IPPS, including new ICD-10-CM/PCS codes, CCs/MCCs, and MS-DRGs, plus insights, analysis and answers to your questions from two of the country’s most respected subject matter experts.
Stay ahead of the 2026-2027 audit surge with “Top 10 Audit Targets for 2026-2027 for Hospitals & Physicians: Protect Your Revenue,” a high-impact webcast led by Michael Calahan, PA, MBA. This concise session gives hospitals and physicians clear insight into the most likely federal audit targets, such as E/M services, split/shared and critical care, observation and admissions, device credits, and Two-Midnight Rule changes, and shows how to tighten documentation, coding, and internal processes to reduce denials, recoupments, and penalties. Attendees walk away with practical best practices to protect revenue, strengthen compliance, and better prepare their teams for inevitable audits.
As AI reshapes healthcare compliance, the risk of biased outputs and opaque decision-making grows. This webcast, led by Frank Cohen, delivers a practical Four-Pillar Governance Framework—Transparency, Accountability, Fairness, and Explainability—to help you govern AI-driven claim auditing with confidence. Learn how to identify and mitigate bias, implement robust human oversight, and document defensible AI review processes that regulators and auditors will accept. Discover concrete remedies, from rotation protocols to uncertainty scoring, and actionable steps to evaluate vendors before contracts are signed. In a regulatory landscape that moves faster than ever, gain the tools to stay compliant, defend your processes, and reduce liability while maintaining operational effectiveness.
Get clear, practical answers to Medicare’s most confusing regulations. Join Dr. Ronald Hirsch as he breaks down real-world compliance challenges and shares guidance your team can apply right away.
Federal auditors are zeroing in on Inpatient Rehabilitation Facility (IRF) and hospital rehab unit services, with OIG and CERT audits leading to millions in penalties—often due to documentation and administrative errors, not quality of care. Join compliance expert Michael Calahan, PA, MBA, to learn the five clinical “pillars” of IRF-PPS admissions, key documentation requirements, and real-life case lessons to help protect your revenue.
Prepare for the 2025 CMS IPPS Final Rule with ICD10monitor’s IPPSPalooza! Click HERE to learn more
Get 15% OFF on all educational webcasts at ICD10monitor with code JULYFOURTH24 until July 4, 2024—start learning today!
CYBER WEEK IS HERE! Don’t miss your chance to get 20% off now until Dec. 1 with code CYBER25
CYBER WEEK IS HERE! Don’t miss your chance to get 20% off now until Dec. 2 with code CYBER24
