Cardiology Coding Alert

Question: One of our cardiologists diagnosed a 50-year-old patient with congestive heart failure (CHF) with class-three symptoms and a right bundle branch block. The physician will be implanting a biventricular pacemaker. Which diagnosis codes should I use? Also, what impact will the new CHF diagnosis codes have on biventricular coding? Wisconsin Subscriber Answer: Without additional information regarding the patient's heart failure, you would report 428.0 (Congestive heart failure, unspecified) and 426.4 (Right bundle branch block). The cardiologist treating the patient may need to provide additional information regarding the specific nature of the heart failure so you can report the CHF to the ultimate level of specificity.

The latest ICD-9 codes expand heart failure from one code (428.0) to 15 codes, which specify systolic, diastolic, acute, chronic, or acute on chronic heart failure. At some point, your carrier may use this substantial revision to further limit reimbursement for biventricular and other procedures. For example, carriers may specify that a patient must have systolic heart failure to justify medical necessity for biventricular implantation. Additionally, carriers may remove the now-unspecified code (428.0) from the list of covered diagnoses because physicians should always code to the highest level of specificity. Carriers will dictate the timeframe, scope and impact of this change and will most likely revise or create new local medical review policies. You should keep an eye on carrier publications. In the meantime, you should update your billing systems to accommodate the new range of heart-failure codes and orient physicians and billing staff to them. When physicians implant biventricular devices, the documentation should reflect indications to the degree of specificity required to implement accurately the new heart-failure codes.