Make Heart Failure Coding a Cinch With These Documentation Tips

Wed, Jul 18, 2018 --

ICD-10, Skill Sharpener

ICD-10-CM coding for heart failure

Cardiology got off fairly light when it comes to 2019 ICD-10-CM changes, so that means you can devote some extra time and energy to refreshing your skills for your top diagnoses, like heart failure. One of the biggest problems experts report seeing in heart failure coding is that documentation supports coding only unspecified heart failure. Let’s look at the terms that will help lead to more specific codes for your acquired heart failure cases.

Zip to the Correct Heart Failure Code With These Terms

These are the major terms you want to have in your heart failure documentation to better match records to codes:

  • Right, left
  • Systolic, diastolic, combined
  • Acute, chronic, acute on chronic.

To break it down even further, this is how the terms fit in the codes:

  • Systolic heart failure
    • Acute (I50.21)
    • Chronic (I50.22)
    • Acute on chronic (I50.23)
  • Diastolic heart failure
    • Acute (I50.31)
    • Chronic (I50.32)
    • Acute on chronic (I50.33)
  • Combined systolic and diastolic
    • Acute (I50.41)
    • Chronic (I50.42)
    • Acute on chronic (I50.43)
  • Right heart failure
    • Acute (I50.811)
    • Chronic (I50.812)
    • Acute on chronic (I50.813)
    • Due to left heart failure (I50.814)
  • Biventricular heart failure (I50.82)
  • High output heart failure (I50.83)
  • End stage heart failure (I50.84).

Read the Notes to Complete Your Heart Failure ICD-10-CM Coding

That list of terms is a good starting point, but the heart failure category includes many “code first,” excludes, inclusion, and “code also” notes. That means you’ve got to dig deeper into the documentation to be sure your coding complies with ICD-10-CM rules.

Two commonly missed instructions are found at the I50.- category level, rather than with specific codes, which may be one reason coders are missing them. (Tip: If you choose an online resource for coding, make sure it has every applicable note listed at code level so you don’t miss any.)

Here are the I50.- instructions that are commonly overlooked:

  • Code first
    • heart failure due to hypertension (I11.0)
    • heart failure due to hypertension with chronic kidney disease (I13.-).

So when one of those combo codes applies, you’d report I11.0 or the I13.- code first, followed by the appropriate code from I50.-.

Some other heart failure (HF) coding notes you’ll want to be sure not to miss include these:

  • When reporting I50.2- for systolic HF, I50.3- for diastolic HF, or I50.4- for combined, code also end stage heart failure, if applicable, using I50.84
  • When reporting I50.814 for right HF due to left HF, I50.82 for biventricular HF, or end stage HF, code also the type HF, if known (I50.2-I50.43).

What About You?

Have you found an approach that works to ensure documentation includes the terms you need for heart failure coding? What is your strategy?

About 

Deborah works on a wide range of TCI SuperCoder projects, researching and writing about coding, as well as assisting with data updates and tool development for our online coding solutions. Since joining TCI in 2004, she’s covered the ins and outs of coding for radiology, cardiology, oncology and hematology, orthopedics, audiology, and more.

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