What are the billing and coding guidelines for a patient with a history of atrial fibrillation (AFib) on Eliquis (apixaban)?

Billing and Coding Guidelines for History of Atrial Fibrillation on Eliquis

For patients with a history of atrial fibrillation (AFib) on Eliquis (apixaban), use ICD-10 code I48.2 for chronic atrial fibrillation and Z79.01 for long-term anticoagulant use.

Primary Diagnosis Codes

• I48.2 - Chronic atrial fibrillation
  • Use this code for patients with persistent or permanent AFib
  • For paroxysmal AFib, use I48.0
  • For unspecified AFib, use I48.91

Secondary Diagnosis Codes

• Z79.01 - Long-term (current) use of anticoagulants
  • This code must be included for patients on Eliquis/apixaban
  • Documents the ongoing anticoagulant therapy

Medication Management Codes

When managing anticoagulation therapy for patients on Eliquis:

• 99211-99215 - Office/outpatient visit codes based on complexity
• 93040-93042 - ECG rhythm strip codes when monitoring is performed
• 85610 - Prothrombin time test (when relevant for transitioning between anticoagulants)

Risk Assessment Documentation

Document the following to support medical necessity:

• CHA₂DS₂-VASc score (stroke risk assessment) 1
• Bleeding risk factors
• Renal function (especially important for Eliquis dosing)
• Weight (≤60 kg is a dose reduction criterion for Eliquis) 2

Eliquis (Apixaban) Dosing Considerations

For proper coding and billing, document the rationale for the specific dosing:

• Standard dose: 5 mg twice daily
• Reduced dose: 2.5 mg twice daily for patients with at least two of:
  • Age ≥80 years
  • Body weight ≤60 kg
  • Serum creatinine ≥1.5 mg/dL 2

Follow-up and Monitoring Codes

• For routine anticoagulation monitoring visits:
  • 99211-99213 - Typically appropriate for stable follow-up
  • Document INR monitoring if transitioning from warfarin (target INR 2.0-3.0) 3
  • For Eliquis, no routine coagulation monitoring is required, but document assessment of adherence, side effects, and bleeding risk

Common Pitfalls to Avoid

1. Missing Z79.01 code - Always include this secondary code for patients on anticoagulants
2. Incorrect AFib type coding - Ensure proper documentation of AFib pattern (paroxysmal, persistent, permanent)
3. Lack of documentation for dose adjustments - Always document specific criteria used for reduced dosing
4. Insufficient risk documentation - Document CHA₂DS₂-VASc score to support medical necessity
5. Missing comorbidities - Include codes for relevant conditions that affect stroke risk (hypertension, diabetes, heart failure)

Special Scenarios

• Perioperative management: Use code Z53.09 (Procedure not carried out because of contraindication) when Eliquis is temporarily discontinued for procedures
• Transition between anticoagulants: Document INR values when transitioning from/to warfarin 2
• Complications: Use appropriate codes for any bleeding events (I60-I62 for intracranial bleeding, K92.2 for gastrointestinal bleeding)

Remember that proper documentation of the CHA₂DS₂-VASc score and other risk factors is essential for supporting medical necessity of anticoagulation therapy in patients with AFib on Eliquis.