Today we are going to take a look at atrial fibrillation and atrial flutter: the difference between the two, the different types, and how to code them.
First, there’s what is the same – atrial fibrillation and atrial flutter are both arrhythmias of the heart that originate in the atria. Both conditions may also share some of the same etiologies and symptoms.
According to cardiovasculardiseasehub, atrial fibrillation is more complex, with a more irregular rhythm than atrial flutter. This is due to the electrical signals in the atria becoming disorganized, which is what makes the atria “fibrillate” or quiver, instead of contracting as normal. This then leads to that irregular rhythm noted in atrial fibrillation. In atrial flutter, on the other hand, the atria beats very rapidly, but in a regular pattern. An electrocardiogram can show differences as well. In atrial flutter, the ECG shows P waves in a “sawtooth” pattern. In atrial fibrillation, an irregular rhythm is noted, without those P waves identified.
Atrial fibrillation and flutter share common etiologies of hypertension, coronary artery disease, heart failure, and valvular heart disease. “AFib,” as it is commonly called, can also be due to hyperthyroidism and sleep apnea, and is more common in those over 65; the incidence increases with age. A flutter can also be seen in patients who have had a previous heart surgery. Both conditions share common symptoms of palpitations, fatigue, dizziness, shortness of breath and chest discomfort. Both conditions also raise the patient’s risk of a stroke, but the risk is greater with atrial fibrillation due to the nature of the electrical impulses and the higher likelihood of blood stasis in the atria.
According to WebMD, paroxysmal atrial fibrillation occurs when the heartbeat returns to normal within seven days, either with or without treatment. We would assign I48.0 for paroxysmal AFib. Persistent AFib lasts longer than a week and would be coded to I48.19. If the persistent AFib is documented to be longstanding, it has lasted more than a year and has not resolved. Longstanding, persistent AFib would be coded to I48.11. We also do have some Coding Clinic guidance on atrial fibrillation I would encourage you to review. The edition published for the second quarter of 2019 instructs us that when there are various types of AFib documented, we should only assign one code for the specific type of AFib, since some of the terms are less specific and some of the types can’t clinically occur together. It also notes that permanent AFib is persistent or longstanding when cardioversion as a treatment is not indicated or can’t be performed. Permanent AFib would be coded to I48.21.
In coding atrial flutter, we can assign I48.92 for unspecified atrial flutter in addition to options for typical or type 1 atrial flutter and atypical or type 2 atrial flutter. According to WebMD, typical atrial flutter is more common (as the name would suggest). This type also involves the tricuspid valve and causes abnormal electrical signals in the right atrium. Typical atrial flutter would be assigned to I48.3. Atypical atrial flutter can occur in either the right or the left atrium, and it does not involve the tricuspid valve. Atypical atrial flutter would be assigned to I48.4. WebMD does note that atrial flutter that comes and goes could be referred to as paroxysmal atrial flutter, and flutter that continues for a longer period of time could be considered persistent atrial flutter. We do not have codes for this specificity…yet.
This week Blue Cross Blue Shield published an article titled “Study suggests AI is boosting hospital billing.” The study was based on data analyzed by
The Centers for Medicare & Medicaid Services (CMS) operates a surveillance platform called the Fraud Prevention System (FPS) that analyzes Medicare claims across the full
Please log in to your account to comment on this article.
Sepsis sequencing continues to challenge even experienced coding and CDI professionals, with evolving guidelines, documentation gaps, and payer scrutiny driving denials and data inconsistencies. In this webcast, Payal Sinha, MBA, RHIA, CCDS, CDIP, CCS, CCS-P, CCDS-O, CRC, CRCR, provides clear guideline-based strategies to accurately code sepsis, severe sepsis, and septic shock, assign POA indicators, clarify the relationship between infection and organ dysfunction, and align documentation across teams. Attendees will gain practical tools to strengthen audit defensibility, improve first-pass accuracy, support appeal success, reduce denials, and ensure accurate quality reporting, empowering organizations to achieve consistent, compliant sepsis coding outcomes.
Expert presenters Kathy Pride, RHIT, CPC, CCS-P, CPMA, and Brandi Russell, RHIA, CCS, COC, CPMA, break down complex fracture care coding rules, walk through correct modifier application (-25, -57, 54, 55), and clarify sequencing for initial and subsequent encounters. Attendees will gain the practical knowledge needed to submit clean claims, ensure compliance, and stay one step ahead of payer audits in 2026.
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.
Federal auditors are intensifying their focus on inpatient psychiatric facilities, using advanced data analytics to spotlight outliers and pursue high‑dollar repayments. In this high‑impact webcast, Michael Calahan, PA, MBA, Compliance Officer and V.P., Hospital & Physician Compliance, breaks down what regulators are really targeting in IPF-PPS admissions, documentation, treatment and discharge planning. Attendees will learn practical steps to tighten processes, avoid common audit triggers and protect reimbursement and reduce the risk of multimillion-dollar repayment demands.
In this timely session, Stacey Shillito, CDIP, CPMA, CCS, CCS-P, CPEDC, COPC, breaks down the complexities of Medical Decision Making (MDM) documentation so providers can confidently capture the true complexity of their care. Attendees will learn practical, efficient strategies to ensure documentation aligns with current E/M guidelines, supports accurate coding, and reduces audit risk, all without adding to charting time.
Join Ronald Hirsch, MD, FACP, CHCQM for The PEPPER Returns – Risk and Opportunity at Your Fingertips, a practical webcast that demystifies the PEPPER and shows you how to turn complex claims data into actionable insights. Dr. Hirsch will explain how to interpret key measures, identify compliance risks, uncover missed revenue opportunities, and understand new updates in the PEPPER, all to help your organization stay ahead of audits and use this powerful data proactively.
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.
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
