I am having a hard time wrapping my head around this. If the patient has chronic systolic left ventricular congestive heart failure, do I code both the I50.22 AND I50.1 or only one or the other?
I would code both as there is no code guidance not to
Thanks for the replies. I did code both as, like you, I found no excludes for one or the other.
I agree that there is not an Excludes 1 note at either code excluding the other.
I would only code the I50.22 because it is more specific about the type of left ventricular failure (or left heart failure).
According to the American Heart Association there are two types of left heart failure: diastolic failure and systolic failure.
I found this on 3M, it is referenced from the ICD-10-CM and ICD-10-PCS Coding Handbook. I underlined a section which may help.
Heart failure occurs when an abnormality of cardiac function results in the inability of the heart to pump blood at a rate commensurate with the body’s needs or the ability to do so only from an abnormal filling pressure. This decrease in blood supply to body tissue results in unmet needs for oxygen as well as in a failure to meet other metabolic requirements. This in turn results in pulmonary and/or systemic circulatory congestion and reduced cardiac output. Precipitating causes of heart failure include cardiac arrhythmias, pulmonary embolism, infections, anemia, thyrotoxicosis, myocarditis, endocarditis, hypertension, and myocardial infarction. All codes for heart failure include any associated pulmonary edema; therefore, no additional code is assigned. A diagnosis of acute pulmonary edema in the absence of underlying heart disease is classified with conditions affecting the respiratory system. (See chapter 19 of this handbook for more information on the respiratory system.)
There are two main categories of heart failure: systolic and diastolic. Systolic heart failure (I50.2-) occurs when the ability of the heart to contract decreases. Diastolic heart failure (I50.3-) occurs when the heart has a problem relaxing between contractions (diastole) to allow enough blood to enter the ventricles. Fifth characters further specify whether the heart failure is unspecified, acute, chronic, or acute on chronic. Please note that physicians may document heart failure with terms such as preserved ejection fraction (HFpEF), heart failure with preserved systolic function, heart failure with reduced ejection fraction (HFrEF), heart failure with low ejection fraction, heart failure with reduced systolic function, or other similar terms. Coders cannot assume the physician means “diastolic heart failure” or “systolic heart failure” and will need to query the provider to clarify whether the patient has diastolic or systolic heart failure.
When the diagnostic statement lists congestive heart failure along with either systolic or diastolic heart failure, only the code for the type of heart failure is assigned: diastolic and/or systolic. Congestive heart failure is included in the codes for systolic and diastolic heart failure. If congestive heart failure is documented without further specification, it is classified to I50.9, Heart failure, unspecified.
Heart dysfunction without mention of heart failure is indexed to I51.89, Other ill-defined heart diseases. It is not appropriate for the coder to assume that a patient is in heart failure when only “diastolic dysfunction” or “systolic dysfunction” is documented.
Heart failure is differentiated clinically by whether the right or left ventricle is primarily affected. Left-sided heart failure (left ventricular failure) is due to the accumulation of excess fluid behind the left ventricle. Code I50.1, Left ventricular failure, includes associated conditions such as dyspnea, orthopnea, bronchospasm, cardiac asthma, edema of lung with heart disease, edema of lung with heart failure, left heart failure, pulmonary edema with heart disease and with heart failure; therefore, no additional codes are assigned. Heart failure, unspecified, is coded to I50.9. This is a vague code, however, and an effort should be made to determine whether a code from the series I50.1 through I50.4- is more appropriate.
Right-sided failure ordinarily follows left-sided failure and is coded in ICD-10-CM as I50.9, Heart failure, unspecified. This code includes any left-sided failure that is present; therefore, codes I50.1 and I50.9 are not assigned for the same episode of care and code I50.9 takes precedence.
The term “congestive heart failure” is often mistakenly used interchangeably with “heart failure.” Congestion--pulmonary or systemic fluid buildup--is one feature of heart failure, but it does not occur in all patients.
Coding Clinic, First Quarter 2009, page 8 advised to code acute on chronic systolic heart failure if a patient is documented as having systolic dysfunction with acute exacerbation of congestive heart failure (CHF) per alphabetic index direction.
In ICD 10, the terms diastolic or systolic are not indexed under the term dysfunction. Does anyone know if the 2009 Coding Clinic advice still stands?
Thanks all for the replies. I did read the 3M information also that was submitted.
No query needed, I would code it to I50.32. HFpEF is diastolic HF and you mention it is documented "chronic" R heart failure. If you didn't have chronic documented, but there is a known history of HF you would code to chronic HF using the below listed coding clinic.
VOLUME 25 THIRD QUARTER
NUMBER 32 2008, Page 12
Chronic Diastolic Congestive Heart Failure
Question: When a patient has a known history of diastolic congestive heart failure, how would this be coded?
Answer: Assign code 428.32, Diastolic heart failure, chronic, and code 428.0, Congestive heart failure unspecified. This is coded as chronic due to the patient's known history.
Congestive heart failure, diastolic/systolic dysfunction, and acute and/or chronic terms have posed some concerns throughout the coding community. The Editorial Advisory Board (EAB) for Coding Clinic is currently reviewing these concerns. This subject is being addressed by the EAB and will be referred to the ICD-9-CM Coordination and Maintenance (C&M) Committee for possible code revisions.
VOLUME 3 THIRD QUARTER
NUMBER 3 2016, Page 46
Heart Failure with Preserved Ejection Fraction, Correction
Question: Coding Clinic, First Quarter 2016, page 10, contained a typographical error. The sentence stating, HFpEF may also be referred to as heart failure with preserved systolic function, and this condition may also be referred to as diastolic heart failure" should read HFpEF may also be referred to as diastolic heart failure."
Linnette Wert RHIT, CCS
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