Skill Sharpener: Add to Your Cardiogenic Shock Coding Knowledge

Wed, Jan 10, 2018 --

ICD-10, Skill Sharpener

ICD-10 coding for cardiogenic shock

Cardiogenic shock may affect treatment outcomes for patients with multivessel coronary artery disease and acute myocardial infarction, so it’s an important diagnosis to document. What is cardiogenic shock, and what are the ICD-10-CM codes for it? Let’s take a look.

Get to Know the Diagnosis

A patient with the medical emergency known as cardiogenic shock has low cardiac output. That means the heart can’t pump enough blood for the body. In cardiogenic shock, this happens suddenly. Damage to the heart (typically the left ventricle) from causes such as a heart attack, inflammation (myocarditis), infection (endocarditis), or drug use may lead to cardiogenic shock.

Some of the symptoms of the condition include tachycardia (rapid heartbeat), reduced urine output, cold extremities, shortness of breath, and low blood pressure.

Review the Codes and Excludes Notes

ICD-10-CM 2018 includes a code specific to cardiogenic shock: R57.0 (Cardiogenic shock). There is an Excludes2 note with the code for septic shock, R65.21 (Severe sepsis with septic shock).

Remember: An Excludes2 note means the excluded condition (septic shock) is not reported using the target code (R57.0). But you may report septic shock at the same time as R57.0 if documentation supports reporting both.

Don’t miss: You need to look beyond the R57.0 code-level rules to ensure accurate coding. Category R57 (Shock, not elsewhere classified) has a long list of Excludes1 notes. Because R57.0 is under R57, those notes apply to R57.0, too, and you should review them to ensure R57.0 is the best code for your case.

Another definition to know: An Excludes1 note means that you should not report the excluded condition at the same time as the target code. Generally, you’ll see an Excludes1 note listing conditions that can’t occur at the same time as the condition in your target code (like a congenital condition code excluding an acquired one).

Exception: If the target-code condition and the excluded condition are unrelated, and both are present, then in those rare cases you may report the target code and the code listed under it in an Excludes1 note.

Back to cardiogenic shock: We took a bit of a detour there into Excludes1, but understanding Excludes1 will help you code cardiogenic shock correctly. When you review the R57 Excludes1 list, watch for postprocedural shock (T81.1-) in the list. ICD-10-CM includes the following codes to use for postprocedural cardiogenic shock:

  • T81.11XA (Postprocedural cardiogenic shock, initial encounter)
  • T81.11XD (Postprocedural cardiogenic shock, subsequent encounter)
  • T81.11XS (Postprocedural cardiogenic shock, sequela).

Don’t Let Cardiogenic Shock Go Unnoticed in Documentation

The presence of cardiogenic shock in a patient with another condition may help support additional reportable services. For instance, a diagnosis of cardiogenic shock may support reporting a right heart catheterization at the same time that you’re reporting endomyocardial biopsy for a distinct reason. You need to be cautious when reporting those two services together, but you also do not want to miss opportunities to report the two together when appropriate.

And for inpatient coders, watch the MCC designation for cardiogenic shock codes R57.0 and T81.11XA.

What About You?

Do you have tips for coding cardiogenic shock? Do you remember to check Excludes1 and Excludes2 notes before you submit your codes?


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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