The National Institute for Health and Clinical Excellence (NICE) has issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on cryoablation for atrial fibrillation in association with other cardiac surgery.
Atrial fibrillation is the irregular and rapid beating of the upper two chambers of the heart (the atria). It may be classified as paroxysmal, persistent or permanent. Patients with atrial fibrillation may be asymptomatic or they may have symptoms including palpitations, dizziness and breathlessness. They also have an increased risk of stroke as a result of blood clots forming in the left atrium and then embolising to the brain. Although atrial fibrillation may occur in the absence of other heart disease, it is particularly common in patients with mitral valve disease.
Cryoablation of the atria can be performed via a catheter introduced through a femoral vein but surgical cryoablation for atrial fibrillation is typically carried out in patients undergoing concomitant open-heart surgery, including mitral valve replacement or repair. A cryoprobe is used to freeze tissue along a pattern of lines rather than the incisions created in the traditional Cox maze surgery.
One of the following codes would be assigned:
K52.1 Open ablation of atrioventricular node
K52.8 Other specified open operations on conducting system of heart
The following code would be assigned in addition to one of the above codes:
Y11.2 Cryotherapy to organ NOC
If code K52.8 is chosen, the site code Z33.6 Atrium of heart is assigned following Y11.2.
Note: Codes are for patients undergoing concomitant open-heart surgery.
In addition ICD-10 code I48.X Atrial fibrillation and flutter would be recorded.
The NHS Classifications Service of NHS Connecting for Health is the central definitive source for clinical coding guidance and determines the coding standards associated with the classifications (OPCS-4 and ICD-10) to be used across the NHS. The NHS Classifications Service and NICE work collaboratively to ensure the most appropriate classification codes are provided. www.connectingforhealth.co.uk/clinicalcoding