The National Institute for Health and Clinical Excellence (NICE) has issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on radiofrequency ablation 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.

Radiofrequency ablation of the atria can be performed via a catheter introduced through a femoral vein but surgical radiofrequency ablation for atrial fibrillation is typically carried out in patients undergoing concomitant open-heart surgery, including mitral valve replacement or repair. Radiofrequency is used to create lines of ablation rather than the incisions created in the traditional Cox maze surgery.

Coding recommendations

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:

Y11.4 Radiofrequency controlled thermal destruction of  organ NOC

If code K52.8 is chosen, the site code Z33.6 Atrium of heart is assigned following Y11.4.

Note: Codes are for patients undergoing concomitant open-heart surgery.

In addition ICD-10 code I48.X Atrial fibrillation and flutter would be recorded.