ICD 10 Coding Alert

Question: A computed tomography (CT) scan of the heart indicates that the patient has hypertensive heart disease with acute systolic congestive heart failure (CHF). Which codes should we report for this condition?

Oregon Subscriber

Answer: You should report I11.0 (Hypertensive heart disease with heart failure) and I50.21 (Acute systolic (congestive) heart failure) for this scenario.

When it comes to understanding sequencing rules, you want to make sure you pay close attention to the “code first” notes that appear in red under code categories like I50- (Heart failure). Per the ICD-10 Official Guidelines for Coding and Reporting, “‘Code first’ notes are also under certain codes that are not specifically manifestation codes but may be due to an underlying cause. When there is a “code first note” and an underlying condition is present, the underlying condition should be sequenced first, if known.”

When you look in the tabular list under category I50-, you discover that the “code first” note tells you to sequence the following underlying conditions first, followed by the appropriate code from category I50- identifying the specific type of heart failure:

• O00.0 (Abdominal pregnancy) through O07- (Failed attempted termination of pregnancy)
• O08- (Complications following ectopic and molar pregnancy)
• I11.0 (Hypertensive heart disease with heart failure)
• I13.- (Hypertensive heart and chronic kidney disease)
• I97.13- (Postprocedural heart failure)
• O75.4 (Other complications of obstetric surgery and procedures)
• I09.81 (Rheumatic heart failure).