Coding, Classification and Reimbursement

Acute (only) CHF with PDX HTN Heart Disease

  • 1.  Acute (only) CHF with PDX HTN Heart Disease

    Posted 02-06-2019 16:25

    When ACUTE (only) SYSTOLIC/DIASTOLIC CHF is assigned with PDX HTN Heart disease, (I11),  is an MCC (since Oct 2018). (Acute on chronic CHF remains an MCC when PDX is HTN Heart and CKD dis).

    But when you  assign ACUTE (only) COMBINED SYSTOLIC/DIASTOLIC CHF it is not considered an MCC.

    Our QA explained it is on the excludes list but had no further information on why combined CHF would be excluded as an MCC when systolic/diastolic only CHF are not.

    Anyone have information on why this would be?
    Thank you

    Deb Hilliard White
    Manager CDS RN CCDS

  • 2.  RE: Acute (only) CHF with PDX HTN Heart Disease

    Posted 02-11-2019 12:45
    A letter has been sent to CMS asking for the rationale for the table changes without apparent inclusion in the final rule as well as ​the lack of extension of exclusion to other acute on chronic HF codes.

    Lori Drodge, RHIT, CCS, APPROVED I10 CM/PCS