Cardiology Coding Alert

Question: “Succeed at Heart Failure Coding With ‘Code First’ and Payer Policy Answers” in Cardiology Coding Alert, vol. 19, no. 3, says, “You should be able to sequence the I50.- codes first if there is no documentation that the patient has one of the conditions listed under the code first instructions with I50.-.” Is there any official statement to support this? I’d like to use it to support my coding.

Tennessee Subscriber

Answer: You’re in luck! AHA Coding Clinic® for ICD-10-CM and ICD-10-PCS, which is acknowledged as an authoritative resource for ICD-10-CM guidance, published relevant guidance in its First Quarter 2016 issue.

The issue posts a question related to payers denying claims with I50.- heart failure claims sequenced first because the payers believe the conditions listed in the “code first” note must be first, even if the patient has none of the listed conditions.

The AHA response is clear: “The ‘code first’ note means code first, if present.” So, if the underlying etiology and manifestation are both present, you must report the etiology first and then the manifestation. But, if the conditions listed in the “code first” note are not present, then the AHA states that the note does not apply.