ICD-10-CM 2018: Succeed at Heart Failure Coding With This New Note Walk-Through

Thu, Aug 31, 2017 --

Coding Updates, ICD-10

heart failure coding

We’re in the home stretch for ICD-10-CM 2018 prep, with about a month to go. We’ve covered the Official Guidelines, but you need to review the new instructions in the code set that come with code revisions, too. Case in point: Let’s take a closer look at the notes you’ll find with the updated diagnosis codes for heart failure (HF).

Size Up Systolic Additions

Inclusion terms: Existing subcategory I50.2- (Systolic (congestive) heart failure) will get two new lines added to clarify that this group of codes applies to these diagnoses:

  • Heart failure with reduced ejection fraction [HFrEF]
  • Systolic left ventricular heart failure.

Code also: There also will be a new instruction to “code also end stage heart failure, if applicable (I50.84),” referencing a new code that will be available when the 2018 code set is effective Oct. 1, 2017.

Don’t Miss Changes to Diastolic

Inclusion terms: Existing subcategory I50.3- (Diastolic (congestive) heart failure) will get three new lines added to clarify that this group of codes applies to these conditions:

  • Diastolic left ventricular heart failure
  • Heart failure with normal ejection fraction
  • Heart failure with preserved ejection fraction [HFpEF].

Code also: Like I50.2-, I50.3- gets a new instruction to “code also end stage heart failure, if applicable (I50.84).”

Keep Up the Pattern for Combined Codes

Inclusion terms: Two new lines let you know the following terms fall under I50.4- (Combined systolic (congestive) and diastolic (congestive) heart failure):

  • Combined systolic and diastolic left ventricular heart failure
  • Heart failure with reduced ejection fraction and diastolic dysfunction.

Code also: This subcategory has a new note you should recognize by now: “Code also end stage heart failure, if applicable (I50.84).”

Navigate New ‘Other HF’ Codes

The big news for HF coding is the addition of new subcategory I50.8- (Other heart failure). Here’s a rundown of the inclusion notes and other instructions you’ll need to apply for these new codes. Be sure to include this information in your clinical documentation improvement training and ICD-10-CM update sessions for providers so they’re aware of the terms ICD-10-CM 2018 uses and how those terms line up with codes.

I50.81- (Right heart failure)

  • Inclusion term
    • Right ventricular failure

I50.810 (Right heart failure, unspecified)

  • Inclusion terms
    • Right heart failure without mention of left heart failure
    • Right ventricular failure NOS

I50.811 (Acute right heart failure)

  • Inclusion terms
    • Acute isolated right heart failure
    • Acute (isolated) right ventricular failure

I50.812 (Chronic right heart failure)

  • Inclusion terms
    • Chronic isolated right heart failure
    • Chronic (isolated) right ventricular failure

I50.813 (Acute on chronic right heart failure)

  • Inclusion terms
    • Acute on chronic isolated right heart failure
    • Acute on chronic (isolated) right ventricular failure
    • Acute decompensation of chronic (isolated) right ventricular failure
    • Acute exacerbation of chronic (isolated) right ventricular failure

I50.814 (Right heart failure due to left heart failure)

  • Inclusion terms
    • Right ventricular failure secondary to left ventricular failure
  • Code also
    • Code also the type of left ventricular failure, if known (I50.2-I50.43)
  • Excludes1
    • Right heart failure with but not due to left heart failure (I50.82)

I50.82 (Biventricular heart failure)

  • Code also
    • Code also the type of heart failure as systolic, diastolic, or combined, if known (I50.2-I50.43)

I50.83 (High output heart failure)

  • No instructions at this code level

I50.84 (End stage heart failure)

  • Inclusion term
    • Stage D heart failure
  • Code also
    • Code also the type of heart failure as systolic, diastolic, or combined, if known (I50.2-I50.43)

I50.89 (Other heart failure)

  • No instructions at this code level

Master What’s Missing From I50.9

Deleted inclusion terms: The notes with existing code I50.9 (Heart failure, unspecified) shrink for ICD-10-CM 2018. What’s missing?

  • Biventricular (heart) failure NOS
    • In 2018, you’ll have I50.82 for biventricular heart failure
  • Right ventricular failure (secondary to left heart failure)
    • In 2018, you’ll have I50.81- for more specific right heart failure coding, including I50.814 for right heart failure due to left heart failure.

What About You?

How do you make sure you know and follow ICD-10-CM notes that apply to your codes?

About 

Deborah concentrates on coding and compliance for radiology and cardiology, including the tricky world of interventional procedures, as well as oncology and hematology. Since joining The Coding Institute in 2004, she’s also covered the ins and outs of coding for orthopedics, audiology, skilled nursing facilities (SNFs), and more.

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