Cardiology Coding Alert
Conquer All Your Heart Failure ICD-10-CM Coding Conundrums
Hint: Report I50.21 for acute systolic heart failure. Heart failure can be tricky to code because you may see numerous acronyms, and you need to decipher whether it’s chronic, acute, or acute on chronic. If you don’t pay close attention to all of the details in the documentation, you run the risk of reporting the wrong code. Learn which codes you will report for different types of heart failure to always report clean claims in your cardiology practice. Differentiate Between Systolic, Diastolic Heart Failure When a patient has heart failure, their heart does not adequately pump blood to meet their body’s need for blood and oxygen. This, in turn, can cause blood and fluids to back up in the patient’s body in their lungs, hands, or feet. Heart failure can be categorized as systolic or diastolic, says Rebecca Sanzone, CPC, CPMA, quality assurance specialist at St. Vincent Medical Group/ Accension Health and coding consultant at the American College of Cardiology. Systolic heart failure: HFrEF is the acronym for heart failure with reduced ejection fraction, which is also known as systolic heart failure. When a patient has systolic heart failure, the left ventricle of their heart is not able to contract normally, so their heart can’t pump with enough force to push enough blood into circulation. The clinical definition of systolic heart failure is an ejection fraction < 50%, Sanzone explains. Diastolic heart failure: HFpEF is the acronym for heart failure with preserved ejection fraction, also called diastolic failure. When a patient suffers from diastolic heart failure, the muscle of the left ventricle has become stiff and won’t relax normally. This results in the heart not adequately filling with blood during the resting period between each heartbeat. In diastolic heart failure, the ejection fraction > = 50%, Sanzone adds. When it comes to common coding issues you might encounter when reporting heart failure, you must know whether the heart failure is diastolic or systolic or both combined, and whether it is acute, chronic, or acute on chronic, Sanzone says. Sometimes physicians do not provide enough information for coders to select the correct ICD-10-CM codes, and this can be a challenge. Don’t miss: “A new term has been recently introduced: heart failure with ‘mid-range’ ejection fraction (HFmrEF) defined as EF is 41-49%,” Sanzone says. “Those who employ the term HFmrEF consider systolic failure to be EF < 41%. The clinical significance of the mid-range EF compared with EF reduced below 41% are yet unknown.” You should code chronic systolic heart failure for patients with heart failure described with reduced, mildly reduced, or mid-range ejection fraction, according to AHA ICD-10-CM Coding Clinic Volume 7, Issue 3, Sanzone says. This makes perfect sense because systolic failure is recognized as EF < 50%, according to Sanzone. Yet another new term has recently been proposed: heart failure with recovered ejection fraction (HFrecEF), which is intended to describe a significant improvement in a reduced EF (systolic heart failure) usually following aortic valve replacement such as TAVR, Sanzone explains. You should code chronic diastolic heart failure for patients with a “recovered” EF that is above 50%, per AHA ICD-10-CM Coding Clinic, Sanzone says. “It does not address what to do about ‘recovery’ to an EF < 50%, which is clinically systolic failure,” Sanzone adds. “If the EF does not recover to normal, a query may be necessary to determine if the recovered EF represents systolic or diastolic failure.” Report These ICD-10-CM Codes for Systolic Heart Failure Look at the following ICD-10-CM codes for systolic congestive heart failure: Under category I50.2- (Systolic (congestive) heart failure), you will notice this range also includes heart failure with reduced ejection fraction (HFrEF) and systolic left ventricular heart failure. Focus on These Options for Diastolic Heart Failure If your cardiologist documents diastolic congestive heart failure, you should turn to category I50.3- (Diastolic (congestive) heart failure). Here are your code choices: Don’t miss: Under category I50.3-, you will see three included conditions: diastolic left ventricular heart failure, heart failure with normal ejection fraction, and heart failure with preserved ejection fraction (HFpEF). Pinpoint Appropriate Combo Codes If your cardiologist documents combined systolic and diastolic heart failure, you should look to category I50.4- (Combined systolic (congestive) and diastolic (congestive) heart failure). These codes also include combined systolic and diastolic left ventricular heart failure and heart failure with reduced ejection fraction and diastolic dysfunction. Your code choices are as follows: Check Out Even More Codes ICD-10-CM offers choices for right heart failure, which includes right ventricular failure. These codes include: Another type of heart failure is biventricular, which you should report with code I50.82 (Biventricular heart failure). A Code also note tells you to also code the type of left ventricular failure as systolic, diastolic, or combined, if known with code I50.2-I50.43. If your cardiologist documents high output heart failure, you should report code I50.83 (High output heart failure). If your cardiologist documents end stage heart failure, report I50.84 (End stage heart failure). This code also includes stage D heart failure. A Code also note tells you to also code the type of left ventricular failure as systolic, diastolic, or combined, if known, with code I50.2-I50.43. If your cardiologist documents unspecified heart failure, you should report I50.9 (Heart failure, unspecified). Code I50.9 also includes cardiac, heart, or myocardial failure NOS; congestive heart disease; and congestive heart failure NOS. Don’t miss: “If the provider does not specify ‘failure’ in his documentation, a code from I50.X would not be assigned,” cautions Robin Peterson, CPC, CPMA, manager of professional coding, Pinnacle Integrated Coding Solutions, LLC. “For example, if the provider only documents left ventricular dysfunction, you would report code I51.9 (Heart disease, unspecified), not a code from the I50.X category.”
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