IPDx: I48.1 (Persistent atrial fibrillation)
SDx: I11.9 (Hypertensive heart disease)
Px: 02564ZZ (Destruction of right atrium, percutaneous endoscopic approach)
02574ZZ (Destruction of left atrium, percutaneous endoscopic approach)
- I48.0: Fibrillation > atrial > paroxysmal
- I11.9: Hypertension, hypertensive > heart > I11.9
- 02564ZZ: Ablation > see Destruction > Atrium > Right > 0256; Atrium > Left > 0257 > go to table 025 and go across the row to assign the remaining characters for the right and left atrium:
- 02574ZZ: Px index > Ablation > see Destruction > Atrium > Left >0256 > locate table 025 and go across the row to assign the remaining characters, noting that the only difference between the two procedures is the right versus the left atrium:
- Destruction is defined in ICD-10-PCS as “Physical eradication of all or a portion of a body part by the use of direct energy, force, or a destructive agent.” Destruction is the root operation in Maze procedures. Because the approach was thorascopic, percutaneous endoscopic approach is assigned. It is defined as “Entry by puncture or minor incision or instrumentation through the skin or mucous membranes and/or any other body layers necessary to reach and visualize the site of the procedure. Thoracoscopy, laparoscopy, arthoscopy are examples of percutaneous endoscopic approach.”
- The Maze Procedure is surgery performed to treat atrial fibrillation. Atrial fibrillation occurs when electrical impulses in the upper chambers of the heart (atria) begin in multiple sites in a chaotic pattern and are sent rapidly to the heart’s lower chambers, causing them to contract irregularly and quickly. The fibrillation or irregular heartbeat can occur for a few minutes, weeks or can continue for a lifetime. Episodes of atrial fibrillation that are brief or intermittent are termed “paroxysmal;” while episodes that last longer and require treatment are referred to as “persistent.”
- During the Maze procedure, a number of incisions are made in the heart tissue of the left and/or right atrium. As the incisions heal, they form scar tissue. It is the scar tissue that prevents the conduction of electricity and disrupts the path of abnormal electrical impulses. The scar tissue also prevents erratic electrical signals from recurring. After the incisions are made, the atrium is sewn back together to allow it to hold blood and contract to push blood into the ventricle. Although the atrium is sewn back together, the erratic electrical paths remain severed so that no unwanted electrical impulse can cross the incision. The result is what looks like a children’s maze in which there is only one path that the electrical impulse can take from the SA node to the AV node. The atrium can no longer fibrillate, and sinus rhythm (the normal rhythm of the heart) is restored.
- AHA’s Coding Clinic, ICD-10-CM and ICD-10-PCS Coding Handbook 2012 by Nelly Leon-Chisen, p. 420.
www.Cedars-Sinai.edu, Atrial Fibrillation, Maze procedure