Q&A: Inpatient admissions for tikosyn-loading

Q: We are getting a number of patients who are admitted for a three-day inpatient stay for tikosyn-loading due to atrial fibrillation (a fib). The DRG weight is very low for these patients, whose diagnosis is usually chronic or persistent a fib. I am wondering if there is any way to improve this?

A: Unfortunately, I do not see any other way that this claim can be coded other than a fib as the principal diagnosis. The Food and Drug Administration (FDA) requires strict guidelines for therapy when tikosyn is initiated and, if necessary, reinitiated, as it can cause life-threatening ventricular arrhythmias. The therapy must be done in a setting that provides continuous electrocardiographic (ECG) monitoring for a minimum of three days and a specialized provider trained in management of serious ventricular arrhythmias must be present. The correct dosage has to be established and kidney functions should also be monitored closely. Additionally, individuals should not be discharged within 12 hours of electrical or pharmacological conversion to normal sinus rhythm.

My guess is that we may see some denials for medical necessity. This is one of those situations where the physician is going to have to write a complete note detailing why the patient requires a three-day inpatient admission with continuous monitoring by trained staff familiar with the FDA regulations. They’ll also need to indicate when it will be safe for the patient to be discharged.  

Finally, I did find the code for Tikosyn, J3490.

Editor’s note: Sharme Brodie, RN, CCDS answered this question. Brodie is a CDI education specialist for HCPro in Middleton, Massachusetts. Contact her at sbrodie@hcpro.com. For information regarding CDI Boot Camps offered by HCPro, visit www.hcprobootcamps.com.