Congestive Heart Failure is a chronic condition characterized by the heart’s weakness and failure to pump effectively to supply the blood to the body affecting the quality of life in the short term and the mortality of the patient in the long term. The heart failure is caused by diseases of the heart or diseases that affect the heart such as coronary artery disease, cardiomyopathy, conduction abnormalities, valvular heart diseases, diabetes, renal diseases et al.
Deriving the type of heart failure whether diastolic, systolic or combined diastolic and systolic from the documentation is very important for the coder to accurately code CHF. Providers do not always use the textbook verbiage and typically paraphrase and hence one must familiarize themselves with the commonly coined terms. Presence of verbiage such as heart failure with preserved ejection fraction denotes that the systolic function is not affected and may denote diastolic heart failure. Similarly, verbiage such as heart failure with reduced ejection fraction denotes that the systolic function is affected and may denote systolic heart failure. Terms such as flare-up, or exacerbation typically denote that the heart failure is chronic and the patient is with acute exacerbation at the current time.
|I50.2 – Systolic (congestive) heart failure||I50.3 – Diastolic (congestive) heart failure|
|I50.20 – Unspecified systolic (congestive) heart failure||I50.30 – Unspecified diastolic (congestive) heart failure|
|I50.21 – Acute systolic (congestive) heart failure||I50.31 – Acute diastolic (congestive) heart failure|
|I50.22 – Chronic systolic (congestive) heart failure||I50.32 – Chronic diastolic (congestive) heart failure|
|I50.23 – Acute on chronic systolic (congestive) heart failure||I50.33 – Acute on chronic diastolic (congestive) heart failure|
AHA Medical Coding Clinic® for ICD-10-CM and ICD-10-PCS, First Quarter 2016
ICD-10-CM Official Guidelines for Coding and Reporting FY 2018
*This article is to help coders improve their knowledge and awareness. Although the article is accurate at the time of publication, coders are requested to refer official guidelines as there are frequent changes.