Coding, Classification & Reimbursement

New Onset = Acute?

  • 1.  New Onset = Acute?

    Posted 10 days ago
    ​I had a CDI tell me today that if a provider documents "new onset heart failure" I can code this as acute.  I know that this cannot be coded any way other than I509 (upon admit).  By discharge, it became HFrEF.  No acute, no exacerbation etc.  She tells me that because this was a new onset at on admit, I can code as acute systolic heart failure. I know I cannot do this.  I've spent time looking in the guidelines, on the Net, AHA's Coding Handbook, next stop is coding clinic, but that can take a while.  Does anyone know where this is stated?  Thanks!!


    Christina Veres, CCS
    Inpatient Coder

  • 2.  RE: New Onset = Acute?

    Posted 9 days ago
    Hello, this is a good question.

    The ACDIS has a forum with CDI asking regarding this matter:

    In the forum, the CDI specialists have come to a consensus that new onset does not mean acute and that the acuity should be queried for clarification with the appropriate clinical indicators.

    I am of the opinion that acuity should never be assumed even though it’s implied based on circumstance.

    Andrea Wong

  • 3.  RE: New Onset = Acute?

    Posted 9 days ago
      |   view attached
    ​The default code for an unspecified CHF is I50.9.  There is no general definition in ICD-10 of acute.  We can look to what guidance we do have in the Official Guidelines re: the terms - but the Default code guideline is really the only one that specifically applies.  See attached.   I would ask the CDI where to produce their official guideline that equates "new onset" to "acute.  This could be applied (erroneously) in many situations - does new onset hypertension mean acute?  Does new onset pancreatitis mean acute?  New onset COPD?  Of course not - it means this is a new diagnosis.  If the patient is admitted to the hospital with significant symptoms that required inpatient care, and after study, the symptoms are attributed to CHF - it may very likely be an acute CHF - however, the provider needs to document as such.  Hope that helps!

    Susan Roehl

  • 4.  RE: New Onset = Acute?

    Posted 9 days ago
    Hi Chris:

    I'm an RN, CDIP-certified, with a formal education in HIM and associated credentials (RHIA and CCS). I disagree with the assertion of your CDI coworker. It may sound silly to a clinician (I'm taking a guess that CDI specialist you are referring to is an RN) to think that "new onset" isn't synonymous with "acute", but we are bound by coding conventions, rules, etc. For this reason, unless there's an organization-wide policy to interpret "new onset" to mean the same as "acute", I would query the provider for clarification. And, again, I expect the provider to be baffled by the query, but I'd stick to the coding rules that if it's not spelled out, you cannot code it.

    Best regards.


    Marina Kravtsova
    Ambulatory Clinical Documentation Specialist
    Health Information Management,RHIA,CDIP,CCS,RN

  • 5.  RE: New Onset = Acute?

    Posted 9 days ago

    Hi Chris,
    Here's a couple links to review, maybe discuss with your managers for a definitive decision, for the sake of team consistency.

    "Acute heart failure is broadly defined as a rapid onset of new or worsening signs and symptoms of HF"



    New-onset HF patients show a clinical profile different to that of chronic-decompensated patients. For this subset of acute HF patients older age, higher comorbidity and beta-blocker nonprescription predict a higher risk of mid-term post-discharge mortality."

    Danita Arrowood, RHIT, CCS, CMDP, CCDS
    Manager, Education Content Development

  • 6.  RE: New Onset = Acute?

    Posted 8 days ago

    Ask for the source.  I agree with others.  "New-onset" is not necessarily synonymous with "acute".  What was the matter?  Did the CDI reviewer not want to take the time to issue a query?

    I do not have the time to express my observations regarding CDI analyst and their coding expertise.  Is that an "oxymoron"?  Do they have accuracy rates they have to maintain?  The same goes with auditors.  I know coders have to maintain 95% or 97.5% accuracy.  Who audits the auditors and the CDI reviewers?

    Lawrence Barr
    Coder 3